Provider Demographics
NPI:1265882054
Name:FLEY, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:FLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3653 SWEET GRASS CIR
Mailing Address - Street 2:5014
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8531
Mailing Address - Country:US
Mailing Address - Phone:407-232-4441
Mailing Address - Fax:
Practice Address - Street 1:3653 SWEET GRASS CIR
Practice Address - Street 2:5014
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8531
Practice Address - Country:US
Practice Address - Phone:407-232-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-21013103K00000X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst