Provider Demographics
NPI:1851150569
Name:GARCIA NICIEZA, MAYDELIS (RBT)
Entity Type:Individual
Prefix:
First Name:MAYDELIS
Middle Name:
Last Name:GARCIA NICIEZA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6908 NW 169TH ST # 148B
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4277
Mailing Address - Country:US
Mailing Address - Phone:786-230-5104
Mailing Address - Fax:
Practice Address - Street 1:6908 NW 169TH ST # 148B
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4277
Practice Address - Country:US
Practice Address - Phone:786-230-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-329561106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty