Provider Demographics
NPI:1659021251
Name:MIKE, DEJANAE (RBT)
Entity Type:Individual
Prefix:MS
First Name:DEJANAE
Middle Name:
Last Name:MIKE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 MERRIMAC TER APT D
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-3737
Mailing Address - Country:US
Mailing Address - Phone:757-338-5067
Mailing Address - Fax:
Practice Address - Street 1:1701 MILITARY TRL STE 142
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6325
Practice Address - Country:US
Practice Address - Phone:561-242-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician