Provider Demographics
NPI:1114655396
Name:CEDENO ARENCIBIA, ADRIANA PATRICIA
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:PATRICIA
Last Name:CEDENO ARENCIBIA
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 1:2850 NEW TAMPA HWY LOT 35
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-8305
Mailing Address - Country:US
Mailing Address - Phone:786-782-5066
Mailing Address - Fax:
Practice Address - Street 1:2850 NEW TAMPA HWY LOT 35
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-8305
Practice Address - Country:US
Practice Address - Phone:786-782-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-226465106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician