Provider Demographics
NPI:1740803048
Name:CORRALES, YANEISY (RBT)
Entity Type:Individual
Prefix:MS
First Name:YANEISY
Middle Name:
Last Name:CORRALES
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 1:9367 FONTAINEBLEAU BLVD APT G108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5636
Mailing Address - Country:US
Mailing Address - Phone:786-362-1355
Mailing Address - Fax:
Practice Address - Street 1:9367 FONTAINEBLEAU BLVD APT G108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-5636
Practice Address - Country:US
Practice Address - Phone:786-362-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-118327106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician