Provider Demographics
NPI:1982484077
Name:MANDIAROTE CASALLAS, ARLET
Entity type:Individual
Prefix:
First Name:ARLET
Middle Name:
Last Name:MANDIAROTE CASALLAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9440 FONTAINEBLEAU BLVD APT 212
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-7528
Mailing Address - Country:US
Mailing Address - Phone:786-854-0455
Mailing Address - Fax:
Practice Address - Street 1:9440 FONTAINEBLEAU BLVD APT 212
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7528
Practice Address - Country:US
Practice Address - Phone:786-854-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT23277865106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119988400Medicaid