Provider Demographics
NPI:1023881711
Name:MESA, YUSIMY (RBT-23-274892)
Entity type:Individual
Prefix:
First Name:YUSIMY
Middle Name:
Last Name:MESA
Suffix:
Gender:F
Credentials:RBT-23-274892
Other - Prefix:
Other - First Name:YUSIMY
Other - Middle Name:
Other - Last Name:MESA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT-23-274892
Mailing Address - Street 1:2055 SW 122ND AVE APT 402
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7357
Mailing Address - Country:US
Mailing Address - Phone:786-398-1636
Mailing Address - Fax:
Practice Address - Street 1:2055 SW 122ND AVE APT 402
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7357
Practice Address - Country:US
Practice Address - Phone:786-398-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-274892106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician