Provider Demographics
NPI:1043841208
Name:PALACIOS, IVONNE LEONELA (RBT)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:LEONELA
Last Name:PALACIOS
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 1:2550 N ALAFAYA TRL APT 12206
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-3638
Mailing Address - Country:US
Mailing Address - Phone:561-856-0181
Mailing Address - Fax:
Practice Address - Street 1:8617 E COLONIAL DR STE 1200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3919
Practice Address - Country:US
Practice Address - Phone:407-930-2569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician