Provider Demographics
NPI:1114417482
Name:SOCARRAS, YENEHT
Entity Type:Individual
Prefix:
First Name:YENEHT
Middle Name:
Last Name:SOCARRAS
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 1:13898 SW 90TH AVE APT EE103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-6991
Mailing Address - Country:US
Mailing Address - Phone:786-217-8650
Mailing Address - Fax:
Practice Address - Street 1:13898 SW 90TH AVE APT EE103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-6991
Practice Address - Country:US
Practice Address - Phone:786-217-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-13
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-17-41626106S00000X
FL1-23-66068103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021728600Medicaid