Provider Demographics
NPI:1760912521
Name:PLASENCIA PEREZ, MARELYS
Entity Type:Individual
Prefix:
First Name:MARELYS
Middle Name:
Last Name:PLASENCIA PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9175 SW 147TH AVE APT 3220
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1416
Mailing Address - Country:US
Mailing Address - Phone:786-486-3624
Mailing Address - Fax:
Practice Address - Street 1:9175 SW 147TH AVE APT 3220
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1416
Practice Address - Country:US
Practice Address - Phone:786-486-3624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FL0-21-12637106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty