Provider Demographics
NPI:1538847389
Name:MONROY, PRISCILLA
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:MONROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DE OLIVEIRA
Other - Middle Name:
Other - Last Name:PRISCILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15424 BLACKBEAD ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4814
Mailing Address - Country:US
Mailing Address - Phone:929-401-2291
Mailing Address - Fax:
Practice Address - Street 1:1701 PARK CENTER DR STE 202701
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6235
Practice Address - Country:US
Practice Address - Phone:407-286-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-283624106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician