Provider Demographics
NPI:1801656657
Name:REYES CASTRO, GUILLERMO ERNESTO (RBT)
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:ERNESTO
Last Name:REYES CASTRO
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-2416
Mailing Address - Country:US
Mailing Address - Phone:239-315-8833
Mailing Address - Fax:
Practice Address - Street 1:400 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-2416
Practice Address - Country:US
Practice Address - Phone:239-315-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-335134106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician