Provider Demographics
NPI:1326687880
Name:ECHEVARRIA, KEIDYS
Entity Type:Individual
Prefix:
First Name:KEIDYS
Middle Name:
Last Name:ECHEVARRIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4576 BELVEDERE RD APT 2
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33415-1381
Mailing Address - Country:US
Mailing Address - Phone:305-440-9050
Mailing Address - Fax:
Practice Address - Street 1:4576 BELVEDERE RD APT 2
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:FL
Practice Address - Zip Code:33415-1381
Practice Address - Country:US
Practice Address - Phone:305-440-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCBA-1-21-50936103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst