Provider Demographics
NPI:1043032535
Name:PINA, ELISSA JULIANA (RBT)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:JULIANA
Last Name:PINA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E 9TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4238
Mailing Address - Country:US
Mailing Address - Phone:786-818-7038
Mailing Address - Fax:
Practice Address - Street 1:135 E 9TH ST APT 8
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4238
Practice Address - Country:US
Practice Address - Phone:786-818-7038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-387700103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst