Provider Demographics
NPI:1407524481
Name:MANCIA, MAYERLI ALEJANDRA (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:MAYERLI
Middle Name:ALEJANDRA
Last Name:MANCIA
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 SW 42ND TER
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-6312
Mailing Address - Country:US
Mailing Address - Phone:954-493-3991
Mailing Address - Fax:
Practice Address - Street 1:1840 SW 42ND TER
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33317-6312
Practice Address - Country:US
Practice Address - Phone:954-493-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-180532106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM520541028270OtherDRIVER LICENSE