Provider Demographics
NPI:1629525852
Name:PINEIRO RODRIGUEZ, GLADYS (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:PINEIRO RODRIGUEZ
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16235 SW 117TH AVE UNIT 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1645
Mailing Address - Country:US
Mailing Address - Phone:305-282-5435
Mailing Address - Fax:
Practice Address - Street 1:16235 SW 117TH AVE UNIT 4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1645
Practice Address - Country:US
Practice Address - Phone:305-282-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106E00000X
251E00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020979900Medicaid