Provider Demographics
NPI:1033769781
Name:VELASCO, JESSICA (RBT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VELASCO
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 1:8975 SW 88TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2133
Mailing Address - Country:US
Mailing Address - Phone:305-815-4666
Mailing Address - Fax:
Practice Address - Street 1:11060 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1272
Practice Address - Country:US
Practice Address - Phone:305-668-8644
Practice Address - Fax:305-668-6010
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-15
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-98576106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-19-98576OtherRBT CERTIFICATION NUMBER