Provider Demographics
NPI:1073213831
Name:HERNANDEZ ACOSTA, YISENIA (RBT)
Entity Type:Individual
Prefix:
First Name:YISENIA
Middle Name:
Last Name:HERNANDEZ ACOSTA
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 1:10817 SW 226TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-6576
Mailing Address - Country:US
Mailing Address - Phone:786-379-7471
Mailing Address - Fax:
Practice Address - Street 1:10817 SW 226TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-6576
Practice Address - Country:US
Practice Address - Phone:786-379-7471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB568208106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician