Provider Demographics
NPI:1255782462
Name:VALLES, MERCEDES (RBT)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:VALLES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 20TH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2534
Mailing Address - Country:US
Mailing Address - Phone:305-602-8073
Mailing Address - Fax:
Practice Address - Street 1:320 W 20TH ST APT 10
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2534
Practice Address - Country:US
Practice Address - Phone:305-602-8073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-05938106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-15-05938Medicaid