Provider Demographics
NPI:1306673140
Name:MOORE, KARIMA (RBT)
Entity type:Individual
Prefix:
First Name:KARIMA
Middle Name:
Last Name:MOORE
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 1:532 SABAL LAKE DR APT 114
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3687
Mailing Address - Country:US
Mailing Address - Phone:510-394-8332
Mailing Address - Fax:
Practice Address - Street 1:15425 SOUTHERN MARTIN ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4898
Practice Address - Country:US
Practice Address - Phone:352-410-1636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1128314106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician