Provider Demographics
NPI:1639958218
Name:PALACIOS, RACHELY (RBT-23-297203)
Entity Type:Individual
Prefix:
First Name:RACHELY
Middle Name:
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:RBT-23-297203
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14250 SW 62ND ST APT 310
Mailing Address - Street 2:
Mailing Address - City:KENDALL
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1931
Mailing Address - Country:US
Mailing Address - Phone:305-302-2820
Mailing Address - Fax:
Practice Address - Street 1:14875 NW 77TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2568
Practice Address - Country:US
Practice Address - Phone:786-321-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-297203103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst