Provider Demographics
NPI:1417742834
Name:REYES ZENEA, YADIAN
Entity type:Individual
Prefix:
First Name:YADIAN
Middle Name:
Last Name:REYES ZENEA
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 1:4885 LUWAL DR
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33415-1303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4885 LUWAL DR
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:FL
Practice Address - Zip Code:33415-1303
Practice Address - Country:US
Practice Address - Phone:561-351-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT24379485106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician