Provider Demographics
NPI:1568226744
Name:BERMUDEZ HERNANDEZ, ELISABEHT
Entity Type:Individual
Prefix:
First Name:ELISABEHT
Middle Name:
Last Name:BERMUDEZ HERNANDEZ
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 1:17310 NW 51ST PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4133
Mailing Address - Country:US
Mailing Address - Phone:305-337-9109
Mailing Address - Fax:
Practice Address - Street 1:17310 NW 51ST PL
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-4133
Practice Address - Country:US
Practice Address - Phone:305-337-9109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-23315742106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician