Provider Demographics
NPI:1336959113
Name:CARBONELL FUENTES, KATHERINE (RBT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:CARBONELL FUENTES
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 1:25505 SW 124TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5865
Mailing Address - Country:US
Mailing Address - Phone:786-298-4652
Mailing Address - Fax:
Practice Address - Street 1:25505 SW 124TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5865
Practice Address - Country:US
Practice Address - Phone:786-298-4652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-387855106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician