Provider Demographics
NPI:1154165793
Name:BARCELO, ILEANA
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:BARCELO
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 1:8005 NW 8TH ST APT 124B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2851
Mailing Address - Country:US
Mailing Address - Phone:305-764-7874
Mailing Address - Fax:
Practice Address - Street 1:8005 NW 8TH ST APT 124B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2851
Practice Address - Country:US
Practice Address - Phone:305-764-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-354569106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician