Provider Demographics
NPI:1417526195
Name:YERA, YUSELY
Entity Type:Individual
Prefix:
First Name:YUSELY
Middle Name:
Last Name:YERA
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 1:3777 NW 78TH AVE APT 10H
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8341
Mailing Address - Country:US
Mailing Address - Phone:305-731-3792
Mailing Address - Fax:
Practice Address - Street 1:3777 NW 78TH AVE APT 10H
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8341
Practice Address - Country:US
Practice Address - Phone:305-731-3792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-142115106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician