Provider Demographics
NPI:1194504514
Name:PLACERES, GRACIELA ANGELICA (RBT)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:ANGELICA
Last Name:PLACERES
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 1:9950 LAKE ELMHURST LN
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4132
Mailing Address - Country:US
Mailing Address - Phone:727-834-0669
Mailing Address - Fax:
Practice Address - Street 1:1060 W STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4919
Practice Address - Country:US
Practice Address - Phone:407-324-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-296600106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician