Provider Demographics
NPI:1962963272
Name:BARCELO SUAREZ, TAMARA HAYDEE
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:HAYDEE
Last Name:BARCELO SUAREZ
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 1:20619 SW 120TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-5336
Mailing Address - Country:US
Mailing Address - Phone:786-283-1032
Mailing Address - Fax:
Practice Address - Street 1:20619 SW 120TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-5336
Practice Address - Country:US
Practice Address - Phone:786-283-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-82124106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty