Provider Demographics
NPI:1336597996
Name:HERNANDEZ, MILENE (RBT 1510064)
Entity Type:Individual
Prefix:
First Name:MILENE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RBT 1510064
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14720 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7777
Mailing Address - Country:US
Mailing Address - Phone:786-406-0141
Mailing Address - Fax:
Practice Address - Street 1:14720 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7777
Practice Address - Country:US
Practice Address - Phone:786-406-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT 1510064103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT 1510064OtherBACB