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General NPI Number Information
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NPI Number | 1699492835
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Entity Type | Individual
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Provider Name | ELIEZER SIMON RBT
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Gender | Male
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 5840 CORPORATE WAY SUITE 105
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City | WEST PALM BEACH
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State | FL
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Zip | 33407
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Country | US
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Telephone | 561-203-0714
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Fax | 561-375-5006
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Provider Business Mailing Address
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Address Line | 5840 CORPORATE WAY SUITE 105
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City | WEST PALM BEACH
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State | FL
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Zip | 33407
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Country | US
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Telephone | 561-203-0714
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Fax | 561-375-5006
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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 | RBT-22-232782
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License Number State | FL
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