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General NPI Number Information
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NPI Number | 1801361035
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Entity Type | Individual
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Provider Name | STANLEY EVARISTE CRT, RBT
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Gender | Male
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Dates
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Enumeration Date | 10/03/2018
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Last Update Date | 10/05/2018
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Provider Practice Location Address
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Address Line | 123 NW 13TH ST STE 300A
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City | BOCA RATON
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State | FL
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Zip | 33432-1624
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Country | US
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Telephone | 561-261-9388
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Fax |
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Provider Business Mailing Address
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Address Line | 2625 NW 53RD ST
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City | TAMARAC
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State | FL
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Zip | 33309-2635
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Country | US
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Telephone |
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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 |
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License Number State |
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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 |
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License Number State |
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