Provider Demographics
NPI:1710684261
Name:BEENE, JOHANY WIDELKY
Entity Type:Individual
Prefix:
First Name:JOHANY
Middle Name:WIDELKY
Last Name:BEENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOHANY
Other - Middle Name:WIDELKY
Other - Last Name:ORTEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6027 MAUSSER DR APT C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2931
Mailing Address - Country:US
Mailing Address - Phone:407-551-9718
Mailing Address - Fax:
Practice Address - Street 1:6027 MAUSSER DR APT C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2931
Practice Address - Country:US
Practice Address - Phone:407-551-9718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-258255106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician