Provider Demographics
NPI:1831870476
Name:CARMONA MENA, ODALYS (RBT)
Entity type:Individual
Prefix:
First Name:ODALYS
Middle Name:
Last Name:CARMONA MENA
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 1:4635 SW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3305
Mailing Address - Country:US
Mailing Address - Phone:305-924-5660
Mailing Address - Fax:
Practice Address - Street 1:4635 SW 18TH ST
Practice Address - Street 2:
Practice Address - City:WEST PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-3305
Practice Address - Country:US
Practice Address - Phone:305-924-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-124525106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty