Provider Demographics
NPI:1093575656
Name:MARRERO CEDENO, GENESIS KRISTAL
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:KRISTAL
Last Name:MARRERO CEDENO
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 1:1318 RAINTREE BND APT 207
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-9618
Mailing Address - Country:US
Mailing Address - Phone:223-280-7059
Mailing Address - Fax:
Practice Address - Street 1:1318 RAINTREE BND APT 207
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-9618
Practice Address - Country:US
Practice Address - Phone:223-280-7059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician