Provider Demographics
NPI:1306456793
Name:MUZAFFARR, SAMIRAH ALENA
Entity type:Individual
Prefix:
First Name:SAMIRAH
Middle Name:ALENA
Last Name:MUZAFFARR
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 1:10661 SW 113TH PL APT A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8291
Mailing Address - Country:US
Mailing Address - Phone:786-908-2645
Mailing Address - Fax:
Practice Address - Street 1:10661 SW 113TH PL APT A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8291
Practice Address - Country:US
Practice Address - Phone:786-908-2645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-127619106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician