Provider Demographics
NPI:1477099372
Name:MITCHELL, VALERIA ALEJANDRA (RBT)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:ALEJANDRA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:VALERIA
Other - Middle Name:ALEJANDRA
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-254-4260
Mailing Address - Fax:239-254-4261
Practice Address - Street 1:3361 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-6826
Practice Address - Country:US
Practice Address - Phone:239-254-4260
Practice Address - Fax:239-254-4261
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X, 106S00000X
FL1-20-45342103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019748000Medicaid