Provider Demographics
NPI:1417716739
Name:RAMIREZ, KEVIN L
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 KINGS DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-5746
Mailing Address - Country:US
Mailing Address - Phone:863-517-2455
Mailing Address - Fax:
Practice Address - Street 1:1703 KINGS DAIRY RD
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-5746
Practice Address - Country:US
Practice Address - Phone:863-517-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1080506106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician