Provider Demographics
NPI:1669129813
Name:RAVELO, HELEN
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:RAVELO
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 1:1408 SE 17TH AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3801
Mailing Address - Country:US
Mailing Address - Phone:239-205-6766
Mailing Address - Fax:
Practice Address - Street 1:1321 WAGNER AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972
Practice Address - Country:US
Practice Address - Phone:239-326-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111334000Medicaid