Provider Demographics
NPI:1982313268
Name:CUEVAS, GENESIS Y
Entity Type:Individual
Prefix:
First Name:GENESIS
Middle Name:Y
Last Name:CUEVAS
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 1:6250 HAZELTINE NATIONAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5102
Mailing Address - Country:US
Mailing Address - Phone:407-237-9955
Mailing Address - Fax:833-792-1182
Practice Address - Street 1:6250 HAZELTINE NATIONAL DR STE 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5102
Practice Address - Country:US
Practice Address - Phone:407-237-9955
Practice Address - Fax:833-792-1182
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT22244588OtherRBT CERTIFICATION NUMBER FROM BACB