Provider Demographics
NPI:1821886276
Name:BEATON NOGUEIRAS, MARINA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:BEATON NOGUEIRAS
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 1:3650 NW 36TH ST APT 802
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-4945
Mailing Address - Country:US
Mailing Address - Phone:786-865-9434
Mailing Address - Fax:
Practice Address - Street 1:3650 NW 36TH ST APT 802
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-4945
Practice Address - Country:US
Practice Address - Phone:786-865-9434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25-424712106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician