Provider Demographics
NPI:1720724370
Name:SOTOMAYOR, JENNY CAROLINA (RBT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:CAROLINA
Last Name:SOTOMAYOR
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 1:1300 N SEMORAN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3567
Mailing Address - Country:US
Mailing Address - Phone:321-890-4038
Mailing Address - Fax:
Practice Address - Street 1:1300 N SEMORAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3567
Practice Address - Country:US
Practice Address - Phone:321-890-4038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20-129416106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician