Provider Demographics
NPI:1346933603
Name:VICTOR, ELAINE (BEHAVIORAL TECH)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:VICTOR
Suffix:
Gender:F
Credentials:BEHAVIORAL TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 NW 25TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5922
Mailing Address - Country:US
Mailing Address - Phone:888-900-7779
Mailing Address - Fax:786-441-4412
Practice Address - Street 1:701 W LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1535
Practice Address - Country:US
Practice Address - Phone:888-900-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLRBT-23-289853106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician