Provider Demographics
NPI:1114547379
Name:CORONADO, MARIA A (BCABA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:CORONADO
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9070 KIMBERLY BLVD STE 19-20
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2855
Mailing Address - Country:US
Mailing Address - Phone:954-988-0918
Mailing Address - Fax:
Practice Address - Street 1:9070 KIMBERLY BLVD STE 19-20
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2855
Practice Address - Country:US
Practice Address - Phone:954-988-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL0-23-14899106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician