Provider Demographics
NPI:1578081782
Name:PACHECO, MAYLE (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:MAYLE
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10332 SW 151ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7773
Mailing Address - Country:US
Mailing Address - Phone:786-715-9968
Mailing Address - Fax:
Practice Address - Street 1:10332 SW 151ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7773
Practice Address - Country:US
Practice Address - Phone:786-715-9968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-21-12010106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst