Provider Demographics
NPI:1659985448
Name:REYES, BERTA CARIDAD (RBT)
Entity Type:Individual
Prefix:
First Name:BERTA
Middle Name:CARIDAD
Last Name:REYES
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 1:14620 SW 151ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5647
Mailing Address - Country:US
Mailing Address - Phone:786-246-1083
Mailing Address - Fax:
Practice Address - Street 1:14620 SW 151ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5647
Practice Address - Country:US
Practice Address - Phone:786-246-1083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst