Provider Demographics
NPI:1699501684
Name:BLACKMAN, MONIQUE R (RBT, CNA)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:R
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:RBT, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2379 NW 167TH ST APT 505
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4574
Mailing Address - Country:US
Mailing Address - Phone:717-201-1317
Mailing Address - Fax:
Practice Address - Street 1:2379 NW 167TH ST APT 505
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4574
Practice Address - Country:US
Practice Address - Phone:717-201-1317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA429118251J00000X
FLRBT-24-375122103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251J00000XAgenciesNursing Care