Provider Demographics
NPI:1629692447
Name:FLEITES NARANJO, YANETSY
Entity Type:Individual
Prefix:
First Name:YANETSY
Middle Name:
Last Name:FLEITES NARANJO
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 1:20176 NW 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1773
Mailing Address - Country:US
Mailing Address - Phone:786-657-6626
Mailing Address - Fax:
Practice Address - Street 1:20176 NW 36TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-1773
Practice Address - Country:US
Practice Address - Phone:786-657-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-121370106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician