Provider Demographics
NPI:1356957187
Name:DOMINGUEZ HERNANDEZ, YANET LILIEN (RBT)
Entity type:Individual
Prefix:
First Name:YANET
Middle Name:LILIEN
Last Name:DOMINGUEZ HERNANDEZ
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 1:6745 SW 132ND AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2388
Mailing Address - Country:US
Mailing Address - Phone:786-366-8087
Mailing Address - Fax:
Practice Address - Street 1:6745 SW 132ND AVE APT 307
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2388
Practice Address - Country:US
Practice Address - Phone:786-366-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-126196103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst