Provider Demographics
NPI:1841961851
Name:CORONA LARA, YANELIS (RBT)
Entity type:Individual
Prefix:
First Name:YANELIS
Middle Name:
Last Name:CORONA LARA
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 1:9452 NW 120TH ST APT 526
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4011
Mailing Address - Country:US
Mailing Address - Phone:305-505-3947
Mailing Address - Fax:
Practice Address - Street 1:9452 NW 120TH ST APT 526
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4011
Practice Address - Country:US
Practice Address - Phone:305-505-3947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-172464103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBACB666597OtherRBT CREDENTIAL