Provider Demographics
NPI:1861170904
Name:VIZCAINO- STEWART, JASMINE ELAINE (RBT)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:ELAINE
Last Name:VIZCAINO- STEWART
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 1:11380 SW 43RD DR APT 6213
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-8013
Mailing Address - Country:US
Mailing Address - Phone:786-818-0284
Mailing Address - Fax:
Practice Address - Street 1:11380 SW 43RD DR APT 6213
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-8013
Practice Address - Country:US
Practice Address - Phone:786-818-0284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB744392106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician