Provider Demographics
NPI:1437915782
Name:TEJERA MARRERO, MARILYN (RBT-21--156857)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:TEJERA MARRERO
Suffix:
Gender:F
Credentials:RBT-21--156857
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 SW 118TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2552
Mailing Address - Country:US
Mailing Address - Phone:786-484-3572
Mailing Address - Fax:
Practice Address - Street 1:866 SW 118TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2552
Practice Address - Country:US
Practice Address - Phone:786-484-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-156857106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician