Provider Demographics
NPI:1043981236
Name:MEJIAS, MARLEN (RBT)
Entity Type:Individual
Prefix:
First Name:MARLEN
Middle Name:
Last Name:MEJIAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:MARLEN
Other - Middle Name:
Other - Last Name:PORTELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5050 TAMIAMI TRL N STE B
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2853
Mailing Address - Country:US
Mailing Address - Phone:239-351-0675
Mailing Address - Fax:239-631-5295
Practice Address - Street 1:1342 SE 46TH LN
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-8617
Practice Address - Country:US
Practice Address - Phone:239-351-3318
Practice Address - Fax:239-673-6895
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-172850106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty