Provider Demographics
NPI:1043058019
Name:NIETO SILVA, ROBERTO JESUS
Entity type:Individual
Prefix:
First Name:ROBERTO JESUS
Middle Name:
Last Name:NIETO SILVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2786 HANNA AVE N
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-5955
Mailing Address - Country:US
Mailing Address - Phone:786-481-8149
Mailing Address - Fax:
Practice Address - Street 1:2786 HANNA AVE N
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-5955
Practice Address - Country:US
Practice Address - Phone:786-481-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-360107106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician