Provider Demographics
NPI:1760165401
Name:LLERENA MENDEZ, JEIDYS (RBT-23-286729)
Entity Type:Individual
Prefix:
First Name:JEIDYS
Middle Name:
Last Name:LLERENA MENDEZ
Suffix:
Gender:F
Credentials:RBT-23-286729
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4765 ORANGE GROVE BLVD APT 5
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4511
Mailing Address - Country:US
Mailing Address - Phone:239-203-5030
Mailing Address - Fax:
Practice Address - Street 1:4765 ORANGE GROVE BLVD APT 5
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4511
Practice Address - Country:US
Practice Address - Phone:239-203-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-286729106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician