Provider Demographics
NPI:1568299915
Name:HUANCAS, JEANETH
Entity type:Individual
Prefix:
First Name:JEANETH
Middle Name:
Last Name:HUANCAS
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 1:4370 NW 79TH AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6344
Mailing Address - Country:US
Mailing Address - Phone:305-607-7085
Mailing Address - Fax:
Practice Address - Street 1:4370 NW 79TH AVE APT 1A
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6344
Practice Address - Country:US
Practice Address - Phone:305-607-7085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT24324599106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician