Provider Demographics
NPI:1326697525
Name:MENA, ELDRICH (RBT)
Entity Type:Individual
Prefix:
First Name:ELDRICH
Middle Name:
Last Name:MENA
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 1:11315 SW 53RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-6837
Mailing Address - Country:US
Mailing Address - Phone:305-542-9013
Mailing Address - Fax:
Practice Address - Street 1:11315 SW 53RD TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-6837
Practice Address - Country:US
Practice Address - Phone:305-542-9013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-96922106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician