Provider Demographics
NPI:1972161685
Name:PRENDES, SAMANTHA DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DE LA CARIDAD
Last Name:PRENDES
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 1:22825 SW 180TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-5411
Mailing Address - Country:US
Mailing Address - Phone:305-972-4059
Mailing Address - Fax:
Practice Address - Street 1:9245 SW 157TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1906
Practice Address - Country:US
Practice Address - Phone:786-701-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-7733106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician