Provider Demographics
NPI:1720814833
Name:QUEVEDO, SAMANTHA L (RBT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:QUEVEDO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 VIA POINCIANA APT 216
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2820
Mailing Address - Country:US
Mailing Address - Phone:561-814-6581
Mailing Address - Fax:
Practice Address - Street 1:1925 BIRKDALE DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5809
Practice Address - Country:US
Practice Address - Phone:954-552-6668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician