Provider Demographics
NPI:1659168920
Name:MAIRENA, IVANIA NICOLE (RBT)
Entity type:Individual
Prefix:
First Name:IVANIA
Middle Name:NICOLE
Last Name:MAIRENA
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3461 SE WILLOUGHBY BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5060
Mailing Address - Country:US
Mailing Address - Phone:772-600-8843
Mailing Address - Fax:
Practice Address - Street 1:4142 SW BAMBERG ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6113
Practice Address - Country:US
Practice Address - Phone:772-985-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-403893106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician