Provider Demographics
NPI:1780484139
Name:DAVILA, HEIDY
Entity type:Individual
Prefix:
First Name:HEIDY
Middle Name:
Last Name:DAVILA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 W 76TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-3808
Mailing Address - Country:US
Mailing Address - Phone:786-716-0669
Mailing Address - Fax:
Practice Address - Street 1:3011 W 76TH ST APT 102
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-3808
Practice Address - Country:US
Practice Address - Phone:786-716-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-418707106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician