Provider Demographics
NPI:1669825097
Name:GACET ACOSTA, YANAY
Entity Type:Individual
Prefix:
First Name:YANAY
Middle Name:
Last Name:GACET ACOSTA
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 1:40 SIDONIA AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3458
Mailing Address - Country:US
Mailing Address - Phone:786-291-6499
Mailing Address - Fax:
Practice Address - Street 1:6025 NW 37TH ST APT 109E
Practice Address - Street 2:
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-7089
Practice Address - Country:US
Practice Address - Phone:786-291-6499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1506600106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician