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General NPI Number Information
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NPI Number | 1568944791
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Entity Type | Individual
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Provider Name | ANDREA BONGGI
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Gender | Female
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 10300 SW 72ND ST STE 114
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City | MIAMI
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State | FL
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Zip | 33173-3038
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Country | US
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Telephone | 305-508-5580
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Fax |
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Provider Business Mailing Address
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Address Line | 14114 SW 93RD LN
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City | MIAMI
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State | FL
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Zip | 33186-1272
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Country | US
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Telephone | 786-260-4779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-19-9456
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-18-56956
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-55665
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License Number State | FL
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