Provider Demographics
NPI:1760009740
Name:AGRAMONTE, MAYKEL
Entity Type:Individual
Prefix:MR
First Name:MAYKEL
Middle Name:
Last Name:AGRAMONTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 NW 3RD TER APT 207
Mailing Address - Street 2:
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-3009
Mailing Address - Country:US
Mailing Address - Phone:305-484-2856
Mailing Address - Fax:
Practice Address - Street 1:1716 NW 3RD TER APT 207
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-3009
Practice Address - Country:US
Practice Address - Phone:305-484-2856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-124695106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician