Provider Demographics
NPI:1457506735
Name:MIMBELA, ROCIO DE BELEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ROCIO
Middle Name:DE BELEN
Last Name:MIMBELA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 CARRIAGE CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5863
Mailing Address - Country:US
Mailing Address - Phone:973-800-6868
Mailing Address - Fax:
Practice Address - Street 1:233 CARRIAGE CROSSING LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5863
Practice Address - Country:US
Practice Address - Phone:973-800-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-30
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1202103K00000X
103K00000X
TX106378235Z00000X
CT006618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist