Provider Demographics
NPI:1104612910
Name:CASANAS ESCOBAR, AYDELIN
Entity type:Individual
Prefix:
First Name:AYDELIN
Middle Name:
Last Name:CASANAS ESCOBAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22718 SW 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1455
Mailing Address - Country:US
Mailing Address - Phone:786-494-0116
Mailing Address - Fax:
Practice Address - Street 1:22718 SW 105TH AVE
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1455
Practice Address - Country:US
Practice Address - Phone:786-494-0116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-428267106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician