Provider Demographics
NPI:1720711161
Name:CASTRO DE GRATEROL, SMIRNA CAROLINA (RBT)
Entity type:Individual
Prefix:
First Name:SMIRNA
Middle Name:CAROLINA
Last Name:CASTRO DE GRATEROL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 NW 107TH AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1824
Mailing Address - Country:US
Mailing Address - Phone:786-609-7284
Mailing Address - Fax:
Practice Address - Street 1:4320 NW 107TH AVE APT 305
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-1824
Practice Address - Country:US
Practice Address - Phone:786-609-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-183869106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician