Provider Demographics
NPI:1326881350
Name:RESTOY, GLORIA (RBT-24-355005)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:RESTOY
Suffix:
Gender:F
Credentials:RBT-24-355005
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6641 WESTCHESTER DR NE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-9529
Mailing Address - Country:US
Mailing Address - Phone:786-223-4108
Mailing Address - Fax:
Practice Address - Street 1:6641 WESTCHESTER DR NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-9529
Practice Address - Country:US
Practice Address - Phone:786-223-4108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-355005106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician