Individual
ANDRE VICUNA BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
4620 N STATE ROAD 7 STE 300, LAUDERDALE LAKES, FL 33319-5867
(185) 583-2672
Mailing address
4620 N STATE ROAD 7 STE 300, LAUDERDALE LAKES, FL 33319-5867
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-36868
—
Other
Enumeration date
02/01/2017
Last updated
04/19/2023
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