Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 02112458 | FL |
N | 106S00000X | Behavior Technician |
NPI | 1164904876 |
---|---|
Provider Name | Mayrelis Rodriguez Chaviano |
First Address | Homestead, FL 33033-1162 |
Second Address | Homestead, FL 33033-1162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2018 |
Last Update Date | 04/08/2021 |