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General NPI Number Information
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NPI Number | 1821765355
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Entity Type | Individual
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Provider Name | LUDIE INNOCENT
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Gender | Female
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 12/15/2024
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Provider Practice Location Address
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Address Line | 5901 SW 74TH ST
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City | MIAMI
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State | FL
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Zip | 33143-5165
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Country | US
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Telephone | 786-953-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 14631 NE 5TH CT
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City | NORTH MIAMI
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State | FL
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Zip | 33161-2120
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Country | US
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Telephone | 754-581-2341
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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 |
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License Number State |
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