Provider Demographics
NPI:1104604552
Name:CRUZ REYES, YANELYS (RBT)
Entity type:Individual
Prefix:
First Name:YANELYS
Middle Name:
Last Name:CRUZ REYES
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 1:1136 E MOWRY DR APT 204
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-8179
Mailing Address - Country:US
Mailing Address - Phone:786-298-4912
Mailing Address - Fax:
Practice Address - Street 1:1136 E MOWRY DR APT 204
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-8179
Practice Address - Country:US
Practice Address - Phone:786-298-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-122530106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty