Provider Demographics
NPI:1275360729
Name:ISLAM, MUNTASEER (RBT)
Entity type:Individual
Prefix:
First Name:MUNTASEER
Middle Name:
Last Name:ISLAM
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 LITTLE RIVER LOOP APT 236
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-1781
Mailing Address - Country:US
Mailing Address - Phone:317-922-4996
Mailing Address - Fax:
Practice Address - Street 1:160 E LAKE BRANTLEY DR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4807
Practice Address - Country:US
Practice Address - Phone:321-972-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician