Provider Demographics
NPI:1104537281
Name:CANALES, DONOVAN J (RBT)
Entity type:Individual
Prefix:
First Name:DONOVAN
Middle Name:J
Last Name:CANALES
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:DONOVAN
Other - Middle Name:J
Other - Last Name:CANALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:731 ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-7319
Mailing Address - Country:US
Mailing Address - Phone:786-431-9665
Mailing Address - Fax:
Practice Address - Street 1:731 ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-7319
Practice Address - Country:US
Practice Address - Phone:786-431-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLC542170980620106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician