Provider Demographics
NPI:1699541037
Name:WARDEN SANTOS, JONNY (RBT-23-312323)
Entity type:Individual
Prefix:
First Name:JONNY
Middle Name:
Last Name:WARDEN SANTOS
Suffix:
Gender:M
Credentials:RBT-23-312323
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 JUSTENE CIR
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936
Mailing Address - Country:US
Mailing Address - Phone:561-891-5896
Mailing Address - Fax:
Practice Address - Street 1:3880 COLONIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1062
Practice Address - Country:US
Practice Address - Phone:561-891-5896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-312323106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician