Provider Demographics
NPI:1679378400
Name:PROENZA RODRIGUEZ, MIRELYS YELENA (RBT)
Entity type:Individual
Prefix:
First Name:MIRELYS
Middle Name:YELENA
Last Name:PROENZA RODRIGUEZ
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 VIA LUGANO CIRCLE
Mailing Address - Street 2:211 APT
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436
Mailing Address - Country:US
Mailing Address - Phone:561-720-3198
Mailing Address - Fax:
Practice Address - Street 1:1100 VIA LUGANO CIRCLE
Practice Address - Street 2:211 APT
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436
Practice Address - Country:US
Practice Address - Phone:561-720-3198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP652-559-00-956-0106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician