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General NPI Number Information
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NPI Number | 1619220498
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Entity Type | Individual
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Provider Name | JOHANNA IVETTE PINA BCBA
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Gender | Female
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 515 RAFAEL BLVD NE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33704-3849
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Country | US
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Telephone | 786-376-3391
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Fax |
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Provider Business Mailing Address
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Address Line | 515 RAFAEL BLVD NE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33704-3849
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Country | US
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Telephone | 786-376-3391
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-17-28059
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 66582
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License Number State | TX
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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 | 1-17-28059
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License Number State | FL
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