Provider Demographics
NPI:1497338677
Name:ATOCHE, MAYRA LEANDRA
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:LEANDRA
Last Name:ATOCHE
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 1:117 PEARY CT UNIT A
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-7715
Mailing Address - Country:US
Mailing Address - Phone:305-916-8326
Mailing Address - Fax:
Practice Address - Street 1:117 PEARY CT UNIT A
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-7715
Practice Address - Country:US
Practice Address - Phone:305-916-8326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21166408106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician