Provider Demographics
NPI:1053762450
Name:RUSSIEL, YARISNEY
Entity type:Individual
Prefix:
First Name:YARISNEY
Middle Name:
Last Name:RUSSIEL
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 1:982 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7277
Mailing Address - Country:US
Mailing Address - Phone:786-718-6141
Mailing Address - Fax:305-901-1797
Practice Address - Street 1:982 W 40TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7277
Practice Address - Country:US
Practice Address - Phone:786-718-6141
Practice Address - Fax:305-901-1797
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician