Basic Information
Provider Information | |||||||||
NPI: | 1467803775 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BLACHE | ||||||||
FirstName: | MICHELLE | ||||||||
MiddleName: | CABRERA | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.S., BCBA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CABRERA | ||||||||
OtherFirstName: | MICHELLE | ||||||||
OtherMiddleName: | SUSAN | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RBT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 500 FAIRWAY DR STE 102 | ||||||||
Address2: |   | ||||||||
City: | DEERFIELD BEACH | ||||||||
State: | FL | ||||||||
PostalCode: | 334411817 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8888809270 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4201 N I 10 SERVICE RD W | ||||||||
Address2: |   | ||||||||
City: | METAIRIE | ||||||||
State: | LA | ||||||||
PostalCode: | 700066713 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8774182978 | ||||||||
FaxNumber: | 8665002186 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/28/2016 | ||||||||
LastUpdateDate: | 05/10/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/10/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-22-58801 | LA | N |   | Behavioral Health & Social Service Providers | Behavioral Analyst |   | 106S00000X | RBT-17-34526 | LA | N |   |   |   |   | 222Q00000X |   |   | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |   | 103K00000X |   | LA | Y |   | Behavioral Health & Social Service Providers | Behavioral Analyst |   |
No ID Information.