Provider Demographics
NPI:1093521742
Name:BARROSO REINA, ANLIE
Entity type:Individual
Prefix:
First Name:ANLIE
Middle Name:
Last Name:BARROSO REINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 NE 203 RD TER
Mailing Address - Street 2:APT E21
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-6001
Mailing Address - Country:US
Mailing Address - Phone:786-821-2158
Mailing Address - Fax:
Practice Address - Street 1:160 NE 203RD TER
Practice Address - Street 2:APT E21
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-6001
Practice Address - Country:US
Practice Address - Phone:786-821-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-389031106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician