Provider Demographics
NPI:1588358717
Name:FLEITES, MAYLENIS
Entity type:Individual
Prefix:
First Name:MAYLENIS
Middle Name:
Last Name:FLEITES
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 1:2500 QUANTUM LAKES DR STE 203
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8323
Mailing Address - Country:US
Mailing Address - Phone:561-409-8240
Mailing Address - Fax:
Practice Address - Street 1:10504 SW 115TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-3100
Practice Address - Country:US
Practice Address - Phone:786-546-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-276619106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician