Provider Demographics
NPI:1619452638
Name:PEREZ, JENNY (RBT-18-66112)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RBT-18-66112
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 SE 13TH PL APT 1
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2610
Mailing Address - Country:US
Mailing Address - Phone:786-217-2040
Mailing Address - Fax:
Practice Address - Street 1:636 SE 13TH PL APT 1
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2610
Practice Address - Country:US
Practice Address - Phone:786-217-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician