Provider Demographics
NPI:1710753553
Name:TARIFA VALDES, ANDRY SR (RBT)
Entity Type:Individual
Prefix:
First Name:ANDRY
Middle Name:
Last Name:TARIFA VALDES
Suffix:SR
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 12TH ST SE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117-3672
Mailing Address - Country:US
Mailing Address - Phone:407-234-6271
Mailing Address - Fax:
Practice Address - Street 1:371 12TH ST SE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34117-3672
Practice Address - Country:US
Practice Address - Phone:407-234-6271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty