Provider Demographics
NPI:1053197079
Name:CARRASCO VALDES, JENNIFER (RBT-23-296225)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CARRASCO VALDES
Suffix:
Gender:F
Credentials:RBT-23-296225
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 W 53RD TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2721
Mailing Address - Country:US
Mailing Address - Phone:305-890-0451
Mailing Address - Fax:
Practice Address - Street 1:395 W 53RD TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2721
Practice Address - Country:US
Practice Address - Phone:305-890-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-296225106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician