Provider Demographics
NPI:1013712819
Name:D AGOSTINI, YUDITH MARIELA (RBT)
Entity type:Individual
Prefix:
First Name:YUDITH
Middle Name:MARIELA
Last Name:D AGOSTINI
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 NW 24TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-4897
Mailing Address - Country:US
Mailing Address - Phone:239-763-1649
Mailing Address - Fax:
Practice Address - Street 1:1211 NW 24TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-4897
Practice Address - Country:US
Practice Address - Phone:239-763-1649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24401389106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician