Provider Demographics
NPI:1720803547
Name:LINARES, LAURA RAQUEL
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:RAQUEL
Last Name:LINARES
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 1:638 FAIRCHILD AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7312
Mailing Address - Country:US
Mailing Address - Phone:386-414-3033
Mailing Address - Fax:
Practice Address - Street 1:638 FAIRCHILD AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7312
Practice Address - Country:US
Practice Address - Phone:386-414-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24379194106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician