Provider Demographics
NPI:1346899424
Name:VALLE, CHABELLY CARIDAD
Entity type:Individual
Prefix:
First Name:CHABELLY
Middle Name:CARIDAD
Last Name:VALLE
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 1:13730 SW 272ND ST APT 208
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7867
Mailing Address - Country:US
Mailing Address - Phone:786-712-6291
Mailing Address - Fax:
Practice Address - Street 1:13730 SW 272ND ST APT 208
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-7867
Practice Address - Country:US
Practice Address - Phone:786-712-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-66633106S00000X
1-24-76155103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician