Provider Demographics
NPI:1588398036
Name:ARAUJO VIDAL, MARIELA
Entity type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:ARAUJO VIDAL
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 1:3G ROBERTA ST
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-5756
Mailing Address - Country:US
Mailing Address - Phone:305-417-2662
Mailing Address - Fax:
Practice Address - Street 1:3G ROBERTA ST
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-5756
Practice Address - Country:US
Practice Address - Phone:305-417-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-140896106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician