Provider Demographics
NPI:1962243386
Name:MONTES DE OCA SUAREZ, YINET
Entity type:Individual
Prefix:
First Name:YINET
Middle Name:
Last Name:MONTES DE OCA SUAREZ
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 1:34 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:PA
Mailing Address - Zip Code:17517-1610
Mailing Address - Country:US
Mailing Address - Phone:717-808-5985
Mailing Address - Fax:
Practice Address - Street 1:115 S 2ND ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:PA
Practice Address - Zip Code:17517-1145
Practice Address - Country:US
Practice Address - Phone:717-808-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARBT-24-349282106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARBT-24-349282OtherBACB