Provider Demographics
NPI:1346003993
Name:PERODIN PEREZ, YESSENIA CARIDAD (RBT-24-324253)
Entity Type:Individual
Prefix:
First Name:YESSENIA
Middle Name:CARIDAD
Last Name:PERODIN PEREZ
Suffix:
Gender:F
Credentials:RBT-24-324253
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15830 BUNCHE PARK SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33054-6961
Mailing Address - Country:US
Mailing Address - Phone:786-881-3595
Mailing Address - Fax:
Practice Address - Street 1:15830 BUNCHE PARK SCHOOL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175
Practice Address - Country:US
Practice Address - Phone:786-881-3595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-324253106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician