Provider Demographics
NPI:1396365730
Name:MIMY, RAYMONDE (RBT)
Entity type:Individual
Prefix:
First Name:RAYMONDE
Middle Name:
Last Name:MIMY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 ALDER DR APT B
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-3205
Mailing Address - Country:US
Mailing Address - Phone:561-689-7722
Mailing Address - Fax:
Practice Address - Street 1:800 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5543
Practice Address - Country:US
Practice Address - Phone:561-741-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-116077106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician