Provider Demographics
NPI:1043797343
Name:PINO ALFONSO, YADEISYS (BCBA)
Entity type:Individual
Prefix:
First Name:YADEISYS
Middle Name:
Last Name:PINO ALFONSO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14490 SW 160TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1700
Mailing Address - Country:US
Mailing Address - Phone:786-286-6904
Mailing Address - Fax:
Practice Address - Street 1:14490 SW 160TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1700
Practice Address - Country:US
Practice Address - Phone:786-286-6904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-57442106S00000X
FL1-24-72823103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician