Provider Demographics
NPI:1194588798
Name:FONSECA PEREZ, ARLET
Entity type:Individual
Prefix:
First Name:ARLET
Middle Name:
Last Name:FONSECA PEREZ
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 1:4911 YORK ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9542
Mailing Address - Country:US
Mailing Address - Phone:239-441-7464
Mailing Address - Fax:
Practice Address - Street 1:4911 YORK ST APT 2
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9542
Practice Address - Country:US
Practice Address - Phone:239-441-7464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-318822106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician