Provider Demographics
NPI:1760165732
Name:LLAMO VALIENTE, EDYLEIDY (RBT-23-287536)
Entity Type:Individual
Prefix:
First Name:EDYLEIDY
Middle Name:
Last Name:LLAMO VALIENTE
Suffix:
Gender:F
Credentials:RBT-23-287536
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13971 WINDRUSH CT APT 10
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4272
Mailing Address - Country:US
Mailing Address - Phone:786-715-7762
Mailing Address - Fax:
Practice Address - Street 1:13971 WINDRUSH CT APT 10
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4272
Practice Address - Country:US
Practice Address - Phone:786-715-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-287536106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty