Provider Demographics
NPI:1508637570
Name:RAMIREZ PEREZ, MARBELIS
Entity Type:Individual
Prefix:
First Name:MARBELIS
Middle Name:
Last Name:RAMIREZ PEREZ
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 1:4424 SUSSEX AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-1739
Mailing Address - Country:US
Mailing Address - Phone:561-545-3048
Mailing Address - Fax:
Practice Address - Street 1:4424 SUSSEX AVE
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-1739
Practice Address - Country:US
Practice Address - Phone:561-545-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1010949106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty