Provider Demographics
NPI:1154165090
Name:RAVELO, LUCY R (BACB1010807)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:R
Last Name:RAVELO
Suffix:
Gender:F
Credentials:BACB1010807
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 NE 191ST ST APT 417
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4280
Mailing Address - Country:US
Mailing Address - Phone:305-834-3745
Mailing Address - Fax:
Practice Address - Street 1:1710 NE 191ST ST APT 417
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-4280
Practice Address - Country:US
Practice Address - Phone:305-834-3745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-346939106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician