Provider Demographics
NPI:1871000299
Name:NELOMS, RAIJEAN
Entity Type:Individual
Prefix:
First Name:RAIJEAN
Middle Name:
Last Name:NELOMS
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 1:1300 NE 109TH ST APT 308
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7321
Mailing Address - Country:US
Mailing Address - Phone:786-285-0191
Mailing Address - Fax:
Practice Address - Street 1:1300 NE 109TH ST APT 308
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-7321
Practice Address - Country:US
Practice Address - Phone:786-285-0191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-110430106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician