Provider Demographics
NPI:1417773318
Name:ABREU SOSA, HADDEN ARIADNE (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:HADDEN
Middle Name:ARIADNE
Last Name:ABREU SOSA
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 BRACK ST APT 2
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4237
Mailing Address - Country:US
Mailing Address - Phone:407-219-0250
Mailing Address - Fax:
Practice Address - Street 1:1725 BUSINESS CENTER LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-1801
Practice Address - Country:US
Practice Address - Phone:407-686-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician