Provider Demographics
NPI:1245902261
Name:BARBON PEREZ, ASALY (REGISTERED BEHAVIOR)
Entity type:Individual
Prefix:
First Name:ASALY
Middle Name:
Last Name:BARBON PEREZ
Suffix:
Gender:M
Credentials:REGISTERED BEHAVIOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 VERNON AVE S
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33973-6103
Mailing Address - Country:US
Mailing Address - Phone:786-704-7232
Mailing Address - Fax:
Practice Address - Street 1:2438 VERNON AVE S
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33973-6103
Practice Address - Country:US
Practice Address - Phone:786-704-7232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-122013106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician