Provider Demographics
NPI:1912695990
Name:RODRIGUEZ PEREZ, YANET
Entity Type:Individual
Prefix:
First Name:YANET
Middle Name:
Last Name:RODRIGUEZ PEREZ
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 1:4576 BELVEDERE RD APT 2
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33415-1381
Mailing Address - Country:US
Mailing Address - Phone:561-389-9525
Mailing Address - Fax:
Practice Address - Street 1:4576 BELVEDERE RD APT 2
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:FL
Practice Address - Zip Code:33415-1381
Practice Address - Country:US
Practice Address - Phone:561-389-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-270622106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician