MEDICARE: MARIANA DE LA CARIDAD PORTALES BCBA

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	103K00000X	Behavior Analyst	1-23-66376	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-23-66376	OTHER	FL	BOARD CERTIFIED BEHAVIOR ANALYST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760039630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANA DE LA CARIDAD PORTALES BCBA

Provider Business Mailing Address
First Line	:	500 MICHIGAN PL
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3846
Country	:	US
Telephone Number	:	561-876-1026
Fax Number	:

Provider Business Practice Location Address
First Line	:	7376 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33467-2529
Country	:	US
Telephone Number	:	561-788-4086
Fax Number	:

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

Provider Enumeration Date	:	08/24/2019
Last Update Date	:	03/19/2026

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