Provider Demographics
NPI:1063264158
Name:WILLIAMS BORRELL, MERCEDES (RBT)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:WILLIAMS BORRELL
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 1:1403 W 44TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7671
Mailing Address - Country:US
Mailing Address - Phone:786-873-8870
Mailing Address - Fax:
Practice Address - Street 1:565 W 51ST PL APT 4
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3631
Practice Address - Country:US
Practice Address - Phone:786-873-8870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-338512106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician