Provider Demographics
NPI:1003527524
Name:DUENAS, GEORGE ALBERTO
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ALBERTO
Last Name:DUENAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-2300
Mailing Address - Country:US
Mailing Address - Phone:786-873-5711
Mailing Address - Fax:
Practice Address - Street 1:1421 JAMES AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-2300
Practice Address - Country:US
Practice Address - Phone:786-873-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-226403106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician