Provider Demographics
NPI:1346561909
Name:DANTES-NORCILUS, ESTONIE (M ED, BCBA)
Entity type:Individual
Prefix:
First Name:ESTONIE
Middle Name:
Last Name:DANTES-NORCILUS
Suffix:
Gender:F
Credentials:M ED, BCBA
Other - Prefix:
Other - First Name:ESTONIE
Other - Middle Name:
Other - Last Name:DANTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5421 NW CLARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983
Mailing Address - Country:US
Mailing Address - Phone:561-396-0230
Mailing Address - Fax:
Practice Address - Street 1:3820 MAX PL APT 208
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-2066
Practice Address - Country:US
Practice Address - Phone:561-396-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X, 385HR2060X, 385HR2065X, 385HR2065X
1-24-77449103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child