Provider Demographics
NPI:1184227555
Name:MEDEROS CARDENAS, MYLENA (BCBA)
Entity Type:Individual
Prefix:
First Name:MYLENA
Middle Name:
Last Name:MEDEROS CARDENAS
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 1:6130 W 19TH AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6041
Mailing Address - Country:US
Mailing Address - Phone:786-378-3867
Mailing Address - Fax:
Practice Address - Street 1:6130 W 19TH AVE APT 109
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6041
Practice Address - Country:US
Practice Address - Phone:786-378-3867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-131971106S00000X
FL1-23-68587103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician