Provider Demographics
NPI:1619625365
Name:NOVOA PEREZ, HAIDEE
Entity Type:Individual
Prefix:
First Name:HAIDEE
Middle Name:
Last Name:NOVOA PEREZ
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 1:390 SW 55TH AVENUE RD APT 8
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1076
Mailing Address - Country:US
Mailing Address - Phone:786-593-4926
Mailing Address - Fax:
Practice Address - Street 1:390 SW 55TH AVENUE RD APT 8
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1076
Practice Address - Country:US
Practice Address - Phone:786-593-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-116776106S00000X
FL107750900106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107750900Medicaid