Provider Demographics
NPI:1841880671
Name:CONSUEGRA, YENI (RBT-20-144762)
Entity type:Individual
Prefix:
First Name:YENI
Middle Name:
Last Name:CONSUEGRA
Suffix:
Gender:F
Credentials:RBT-20-144762
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 GIULIANO AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3729
Mailing Address - Country:US
Mailing Address - Phone:813-526-2072
Mailing Address - Fax:
Practice Address - Street 1:3010 GIULIANO AVE
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3729
Practice Address - Country:US
Practice Address - Phone:813-526-2072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty