Provider Demographics
NPI:1598479727
Name:ARDINES BONACHEA, ALEXIS (CBHT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:ARDINES BONACHEA
Suffix:
Gender:M
Credentials:CBHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E 53RD TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1457
Mailing Address - Country:US
Mailing Address - Phone:786-317-7363
Mailing Address - Fax:
Practice Address - Street 1:151 E 53RD TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1457
Practice Address - Country:US
Practice Address - Phone:786-317-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM103830171M00000X
FLCBHT.0100373106S00000X
FLRBT-23-300122106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator