Provider Demographics
NPI:1447031497
Name:FIRVIDA, YENY
Entity type:Individual
Prefix:MISS
First Name:YENY
Middle Name:
Last Name:FIRVIDA
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 1:622 S FEDERAL HWY APT 2
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-4905
Mailing Address - Country:US
Mailing Address - Phone:561-888-5568
Mailing Address - Fax:
Practice Address - Street 1:622 S FEDERAL HWY APT 2
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33460-4905
Practice Address - Country:US
Practice Address - Phone:561-888-5568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-301891106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician