Provider Demographics
NPI:1497403190
Name:CELY, ANGELA ROCIO (RBT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ROCIO
Last Name:CELY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:CELY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:1283 BOLIN AVE NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1254
Mailing Address - Country:US
Mailing Address - Phone:786-908-7745
Mailing Address - Fax:
Practice Address - Street 1:1283 BOLIN AVE NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1254
Practice Address - Country:US
Practice Address - Phone:786-908-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-156790106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician