Provider Demographics
NPI:1477201796
Name:BENITEZ TAMAYO, LETICIA SR (RBT-20-129865)
Entity Type:Individual
Prefix:PROF
First Name:LETICIA
Middle Name:
Last Name:BENITEZ TAMAYO
Suffix:SR
Gender:F
Credentials:RBT-20-129865
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 E MOWRY DR APT 1311
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-8118
Mailing Address - Country:US
Mailing Address - Phone:786-752-1989
Mailing Address - Fax:
Practice Address - Street 1:826 E MOWRY DR APT 1311
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-8118
Practice Address - Country:US
Practice Address - Phone:786-752-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-129865106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician