Provider Demographics
NPI:1033809900
Name:RAMIREZ VALDES, SUSELL
Entity Type:Individual
Prefix:
First Name:SUSELL
Middle Name:
Last Name:RAMIREZ VALDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 SAN MATEO DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-1522
Mailing Address - Country:US
Mailing Address - Phone:561-921-7861
Mailing Address - Fax:
Practice Address - Street 1:448 SAN MATEO DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-1522
Practice Address - Country:US
Practice Address - Phone:561-921-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-272367106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician