Provider Demographics
NPI:1912142852
Name:LANUZA, ROBERTO ALFONSO (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ALFONSO
Last Name:LANUZA
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SEMMES AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1339
Mailing Address - Country:US
Mailing Address - Phone:786-369-1725
Mailing Address - Fax:
Practice Address - Street 1:54 SEMMES AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1339
Practice Address - Country:US
Practice Address - Phone:786-369-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-08-4420103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst