MEDICARE: NICOLE SOSA HERRERA RBT-23-313286

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-23-313286	FL

General Provider Information

NPI Number	:	1548037559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE SOSA HERRERA RBT-23-313286

Provider Business Mailing Address
First Line	:	2348 FAIRWAY DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6238
Country	:	US
Telephone Number	:	939-270-2874
Fax Number	:

Provider Business Practice Location Address
First Line	:	2348 FAIRWAY DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6238
Country	:	US
Telephone Number	:	939-270-2874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	12/08/2023

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