Provider Demographics
NPI:1124876743
Name:RUBIELLA ALFONSO, ANA IRIS (RBT)
Entity type:Individual
Prefix:
First Name:ANA IRIS
Middle Name:
Last Name:RUBIELLA ALFONSO
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 1:921 N C ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-2438
Mailing Address - Country:US
Mailing Address - Phone:737-225-2699
Mailing Address - Fax:
Practice Address - Street 1:921 N C ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33460-2438
Practice Address - Country:US
Practice Address - Phone:737-225-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT--24-343264106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician