Provider Demographics
NPI:1033946629
Name:ASSON, QUBILAH WASIMAH
Entity type:Individual
Prefix:
First Name:QUBILAH
Middle Name:WASIMAH
Last Name:ASSON
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 1:4220 SW SAVONA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7242
Mailing Address - Country:US
Mailing Address - Phone:561-729-7228
Mailing Address - Fax:
Practice Address - Street 1:4220 SW SAVONA BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-7242
Practice Address - Country:US
Practice Address - Phone:561-729-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-377883106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician