Provider Demographics
NPI:1831891662
Name:ACOSTA CHAVEZ, AMARILIS
Entity type:Individual
Prefix:
First Name:AMARILIS
Middle Name:
Last Name:ACOSTA CHAVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9917 W OKEECHOBEE RD APT 4402
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2168
Mailing Address - Country:US
Mailing Address - Phone:786-328-1924
Mailing Address - Fax:
Practice Address - Street 1:9917 W OKEECHOBEE RD APT 4402
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2168
Practice Address - Country:US
Practice Address - Phone:786-328-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician