Provider Demographics
NPI:1720805542
Name:ESCANDELL REYES, ARACELYS CARIDAD
Entity type:Individual
Prefix:
First Name:ARACELYS
Middle Name:CARIDAD
Last Name:ESCANDELL REYES
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 1:6947 LACY DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-5663
Mailing Address - Country:US
Mailing Address - Phone:561-215-2733
Mailing Address - Fax:
Practice Address - Street 1:6947 LACY DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-5663
Practice Address - Country:US
Practice Address - Phone:561-215-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-374548106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty