Provider Demographics
NPI:1558002915
Name:PEREZ ALBISA, EDEL (RBT)
Entity Type:Individual
Prefix:
First Name:EDEL
Middle Name:
Last Name:PEREZ ALBISA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 COLUMBUS BLVD S
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974-4714
Mailing Address - Country:US
Mailing Address - Phone:786-343-3580
Mailing Address - Fax:
Practice Address - Street 1:438 COLUMBUS BLVD S
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33974-4714
Practice Address - Country:US
Practice Address - Phone:786-343-3580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-205183106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty