Provider Demographics
NPI:1871155465
Name:BAVARESCO, NORMA PATRICIA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:NORMA
Middle Name:PATRICIA
Last Name:BAVARESCO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7240 NW 114TH AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-5568
Mailing Address - Country:US
Mailing Address - Phone:786-280-0937
Mailing Address - Fax:
Practice Address - Street 1:7875 NW 107TH AVE APT 416
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4421
Practice Address - Country:US
Practice Address - Phone:786-280-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-19-9826106E00000X
FL1-20-46199103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst