Provider Demographics
NPI:1609223577
Name:MORALES VALDIVIA, YANISLEY
Entity Type:Individual
Prefix:
First Name:YANISLEY
Middle Name:
Last Name:MORALES VALDIVIA
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 1:19954 NW 60TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4876
Mailing Address - Country:US
Mailing Address - Phone:786-461-9978
Mailing Address - Fax:
Practice Address - Street 1:1660 SOUTHERN BLVD STE C
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-3219
Practice Address - Country:US
Practice Address - Phone:786-461-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCBA1-20-40603103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst