Provider Demographics
NPI:1467231464
Name:ESTIVENE, NADEGE VICTOR (RBT)
Entity Type:Individual
Prefix:
First Name:NADEGE
Middle Name:VICTOR
Last Name:ESTIVENE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 SE CLEARMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-4045
Mailing Address - Country:US
Mailing Address - Phone:908-294-1979
Mailing Address - Fax:
Practice Address - Street 1:1665 SE CLEARMONT ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-4045
Practice Address - Country:US
Practice Address - Phone:908-294-1979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLRBT-23-31-3448106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician