Provider Demographics
NPI:1245886480
Name:PENA MAREY, YAMILEYDI
Entity type:Individual
Prefix:
First Name:YAMILEYDI
Middle Name:
Last Name:PENA MAREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 FOXBORO DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6256
Mailing Address - Country:US
Mailing Address - Phone:305-833-8210
Mailing Address - Fax:
Practice Address - Street 1:14001 VILLAGE TERRACE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-6900
Practice Address - Country:US
Practice Address - Phone:305-833-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FL1-24-70852103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician