Provider Demographics
NPI:1326626946
Name:TRETO PEREZ, MARLEN (RBT)
Entity Type:Individual
Prefix:
First Name:MARLEN
Middle Name:
Last Name:TRETO PEREZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 NE 16TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4819
Mailing Address - Country:US
Mailing Address - Phone:786-379-9769
Mailing Address - Fax:
Practice Address - Street 1:230 NE 16TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4819
Practice Address - Country:US
Practice Address - Phone:786-379-9769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB552749106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician