Provider Demographics
NPI:1174820286
Name:PUERTO, YILIANA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:YILIANA
Middle Name:
Last Name:PUERTO
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 1:4620 N STATE ROAD 7 STE 300
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5867
Mailing Address - Country:US
Mailing Address - Phone:877-535-7888
Mailing Address - Fax:561-990-1334
Practice Address - Street 1:4620 N STATE ROAD 7 STE 300
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5867
Practice Address - Country:US
Practice Address - Phone:877-535-7888
Practice Address - Fax:561-990-1334
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-12-12659103K00000X
FL0-10-3819103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-12-12659OtherBEHAVIOR ANALYST CERTIFICATION BOARD