Provider Demographics
NPI:1942678099
Name:LLANES, STEPHANIE ELYSE (RBT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ELYSE
Last Name:LLANES
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 1:12771 SW 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4764
Mailing Address - Country:US
Mailing Address - Phone:305-431-3350
Mailing Address - Fax:
Practice Address - Street 1:8001 SW 36TH ST STE 9
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1915
Practice Address - Country:US
Practice Address - Phone:954-577-7790
Practice Address - Fax:954-577-7780
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-07
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-19-36273103K00000X
103K00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician