Provider Demographics
NPI:1598340952
Name:CEPERO QUINTANA, ODALYS YANET (RBT)
Entity Type:Individual
Prefix:
First Name:ODALYS
Middle Name:YANET
Last Name:CEPERO QUINTANA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N 65TH WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7609
Mailing Address - Country:US
Mailing Address - Phone:954-865-5957
Mailing Address - Fax:
Practice Address - Street 1:2240 PALM BEACH LAKES BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3406
Practice Address - Country:US
Practice Address - Phone:786-709-7932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst