Provider Demographics
NPI:1851096853
Name:CARRALERO NEYRA, CARLOS VICTOR (RBT)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:VICTOR
Last Name:CARRALERO NEYRA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4520
Mailing Address - Country:US
Mailing Address - Phone:407-350-4037
Mailing Address - Fax:407-350-4871
Practice Address - Street 1:911 N MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4520
Practice Address - Country:US
Practice Address - Phone:407-350-4037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-262482106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician