Provider Demographics
NPI:1811493653
Name:VILLA ESCOBAR, MAYDE DENISES (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:MAYDE
Middle Name:DENISES
Last Name:VILLA ESCOBAR
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:MAYDE
Other - Middle Name:DENISES
Other - Last Name:VILLA ESCOBAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BEHAVIOR TECHNICIAN
Mailing Address - Street 1:9703 HAMMOCKS BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1557
Mailing Address - Country:US
Mailing Address - Phone:786-458-4467
Mailing Address - Fax:
Practice Address - Street 1:9703 HAMMOCKS BLVD APT 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1557
Practice Address - Country:US
Practice Address - Phone:786-458-4467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician