Provider Demographics
NPI:1033727094
Name:BAYLAC MINGO, SOFIA (BCBA, MS)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:BAYLAC MINGO
Suffix:
Gender:F
Credentials:BCBA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 TREE RIDGE LN NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4663
Mailing Address - Country:US
Mailing Address - Phone:954-592-3295
Mailing Address - Fax:
Practice Address - Street 1:333 W 41ST ST STE 414
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3608
Practice Address - Country:US
Practice Address - Phone:786-673-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2024-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-19-90259106S00000X
1-24-77432103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician