Provider Demographics
NPI:1124759204
Name:FAVA, JAIDEN CORINNE (RBT)
Entity type:Individual
Prefix:
First Name:JAIDEN
Middle Name:CORINNE
Last Name:FAVA
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:JAIDEN
Other - Middle Name:CORINNE
Other - Last Name:MANIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1500 S DOUGLAS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4108
Mailing Address - Country:US
Mailing Address - Phone:844-244-1818
Mailing Address - Fax:
Practice Address - Street 1:440 STUART RD NE STE 2
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4959
Practice Address - Country:US
Practice Address - Phone:423-451-8747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician