Provider Demographics
NPI:1639833148
Name:RAMIREZ MOJENA, THALIA (RBT)
Entity Type:Individual
Prefix:
First Name:THALIA
Middle Name:
Last Name:RAMIREZ MOJENA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:THALIA
Other - Middle Name:
Other - Last Name:RAMIREZ MOJENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:2209 W HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-3621
Mailing Address - Country:US
Mailing Address - Phone:727-637-5301
Mailing Address - Fax:
Practice Address - Street 1:2209 W HANCOCK ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-3621
Practice Address - Country:US
Practice Address - Phone:727-637-5301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-30
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-190585106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician