Provider Demographics
NPI:1245820117
Name:PEREZ ENCARNACION, HEROL GUSTAVO (RBT)
Entity type:Individual
Prefix:
First Name:HEROL
Middle Name:GUSTAVO
Last Name:PEREZ ENCARNACION
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13934 MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8611
Mailing Address - Country:US
Mailing Address - Phone:561-215-6084
Mailing Address - Fax:
Practice Address - Street 1:2711 EXCHANGE CT
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-4017
Practice Address - Country:US
Practice Address - Phone:561-900-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-152152106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician