Provider Demographics
NPI:1578394375
Name:NODARSE, LAURA ELINA (RBT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELINA
Last Name:NODARSE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELINA
Other - Last Name:NODARSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:17945 SW 97TH AVE APT 537
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5460
Mailing Address - Country:US
Mailing Address - Phone:786-782-6568
Mailing Address - Fax:
Practice Address - Street 1:17945 SW 97TH AVE APT 537
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5460
Practice Address - Country:US
Practice Address - Phone:786-782-6568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-368962106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician