Provider Demographics
NPI:1134661572
Name:FLEITES VALDES, YACSA (BCBA 1-20-41752)
Entity Type:Individual
Prefix:
First Name:YACSA
Middle Name:
Last Name:FLEITES VALDES
Suffix:
Gender:F
Credentials:BCBA 1-20-41752
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10294 FAIRWAY HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1575
Mailing Address - Country:US
Mailing Address - Phone:786-606-4348
Mailing Address - Fax:
Practice Address - Street 1:2235 EVEREST PKWY
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-3351
Practice Address - Country:US
Practice Address - Phone:786-606-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-18-8868106E00000X
106S00000X
FL1-20-41752103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019615500Medicaid