Provider Demographics
NPI:1306427315
Name:SEIBANE, DORA MARIA
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:MARIA
Last Name:SEIBANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 BRIDGEWATER CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-4141
Mailing Address - Country:US
Mailing Address - Phone:305-490-2174
Mailing Address - Fax:
Practice Address - Street 1:449 BRIDGEWATER CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-4141
Practice Address - Country:US
Practice Address - Phone:305-490-2174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-164159106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician