Provider Demographics
NPI:1912669458
Name:TAVERAS, LUIS MIGUEL
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:MIGUEL
Last Name:TAVERAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7694 BLAIRWOOD CIR S
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1806
Mailing Address - Country:US
Mailing Address - Phone:786-626-1692
Mailing Address - Fax:
Practice Address - Street 1:500 S AUSTRALIAN AVE STE 600
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-6237
Practice Address - Country:US
Practice Address - Phone:877-857-8517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-189174106S00000X
FL1-25-78881103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician