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General NPI Number Information
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NPI Number | 1598504854
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Entity Type | Individual
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Provider Name | TRINITY RIVERS RBT
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Gender | Female
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 1515 INDIAN RIVER BLVD STE A210
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City | VERO BEACH
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State | FL
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Zip | 32960-7107
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Country | US
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Telephone | 772-774-8224
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Fax | 772-774-8275
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Provider Business Mailing Address
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Address Line | 2155 ROBERT J CONLAN BLVD NE # 3-114
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City | PALM BAY
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State | FL
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Zip | 32905-2709
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Country | US
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Telephone | 256-366-9949
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-324296
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License Number State |
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