Provider Demographics
NPI:1043009301
Name:MATUTE PACHECO, YANETH G
Entity type:Individual
Prefix:
First Name:YANETH
Middle Name:G
Last Name:MATUTE PACHECO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 RAINBOW SPRINGS TER
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4223
Mailing Address - Country:US
Mailing Address - Phone:561-693-9020
Mailing Address - Fax:
Practice Address - Street 1:415 RAINBOW SPRINGS TER
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4223
Practice Address - Country:US
Practice Address - Phone:561-693-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-431720106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician