Provider Demographics
NPI:1598581514
Name:QUINTANA, BESSY
Entity type:Individual
Prefix:MRS
First Name:BESSY
Middle Name:
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16384 SANDY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-7028
Mailing Address - Country:US
Mailing Address - Phone:561-603-8708
Mailing Address - Fax:
Practice Address - Street 1:16384 SANDY SHORE DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:FL
Practice Address - Zip Code:33470-7028
Practice Address - Country:US
Practice Address - Phone:561-603-8708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACBB1033153106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician