Provider Demographics
NPI:1427543792
Name:BALLESTEROS TORRES, YENNY D
Entity Type:Individual
Prefix:
First Name:YENNY
Middle Name:D
Last Name:BALLESTEROS TORRES
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 1:5733 SW 148TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2421
Mailing Address - Country:US
Mailing Address - Phone:786-908-7371
Mailing Address - Fax:
Practice Address - Street 1:5733 SW 148TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2421
Practice Address - Country:US
Practice Address - Phone:786-908-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020551900Medicaid