Provider Demographics
NPI:1164198511
Name:MEZAWI, YORDANKA (BCBA)
Entity Type:Individual
Prefix:
First Name:YORDANKA
Middle Name:
Last Name:MEZAWI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24298 SW 113 PSGE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-3131
Mailing Address - Country:US
Mailing Address - Phone:786-202-1701
Mailing Address - Fax:
Practice Address - Street 1:24298 SW 113 PSGE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-3131
Practice Address - Country:US
Practice Address - Phone:786-202-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB480273103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst