Provider Demographics
NPI:1063147189
Name:MORALES RODRIGUEZ, MARLENY (RBT)
Entity type:Individual
Prefix:
First Name:MARLENY
Middle Name:
Last Name:MORALES RODRIGUEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3067 SW LUCERNE ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4420
Mailing Address - Country:US
Mailing Address - Phone:772-626-8437
Mailing Address - Fax:
Practice Address - Street 1:3067 SW LUCERNE ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4420
Practice Address - Country:US
Practice Address - Phone:772-626-8437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-224794106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician