Provider Demographics
NPI:1942061080
Name:FEO LUIS, MARYLEIDI (RBT-23-318914)
Entity Type:Individual
Prefix:
First Name:MARYLEIDI
Middle Name:
Last Name:FEO LUIS
Suffix:
Gender:F
Credentials:RBT-23-318914
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7781 NW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5262
Mailing Address - Country:US
Mailing Address - Phone:561-307-0582
Mailing Address - Fax:
Practice Address - Street 1:7781 NW 15TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-5262
Practice Address - Country:US
Practice Address - Phone:561-307-0582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-318914106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician