Provider Demographics
NPI:1124629217
Name:ARAOZ CANEDO, MARI (RBT)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:ARAOZ CANEDO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 NW 5TH AVE APT 508
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-3167
Mailing Address - Country:US
Mailing Address - Phone:305-310-9865
Mailing Address - Fax:
Practice Address - Street 1:3606 NW 5TH AVE APT 508
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3167
Practice Address - Country:US
Practice Address - Phone:305-310-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-21-12781106E00000X, 106E00000X
FLRBT-18-58737106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105380600Medicaid