Provider Demographics
NPI:1699511220
Name:JUNCOSA HERNANDEZ, CHABELY (RBT)
Entity type:Individual
Prefix:
First Name:CHABELY
Middle Name:
Last Name:JUNCOSA HERNANDEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6172 SW 164TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5742
Mailing Address - Country:US
Mailing Address - Phone:305-298-7757
Mailing Address - Fax:
Practice Address - Street 1:12985 SW 130TH CT STE 108-4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5312
Practice Address - Country:US
Practice Address - Phone:786-282-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-355852106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician