Provider Demographics
NPI:1902678378
Name:MACOLA HERNANDEZ, MAHELYS
Entity type:Individual
Prefix:
First Name:MAHELYS
Middle Name:
Last Name:MACOLA HERNANDEZ
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 1:2500 N MILITARY TRL STE 304
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6324
Mailing Address - Country:US
Mailing Address - Phone:561-421-5111
Mailing Address - Fax:561-421-5222
Practice Address - Street 1:2500 N MILITARY TRL STE 304
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6324
Practice Address - Country:US
Practice Address - Phone:561-421-5111
Practice Address - Fax:561-421-5222
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician