Provider Demographics
NPI:1902668908
Name:COSSIO, MARICELA
Entity type:Individual
Prefix:
First Name:MARICELA
Middle Name:
Last Name:COSSIO
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 1:13548 TURTLE MARSH LOOP APT 419
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6616
Mailing Address - Country:US
Mailing Address - Phone:321-310-7229
Mailing Address - Fax:
Practice Address - Street 1:13548 TURTLE MARSH LOOP APT 419
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6616
Practice Address - Country:US
Practice Address - Phone:321-310-7229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-319492106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician