Provider Demographics
NPI:1447060637
Name:CARDENTEY BORROTO, BANESSA
Entity type:Individual
Prefix:MRS
First Name:BANESSA
Middle Name:
Last Name:CARDENTEY BORROTO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BANESSA
Other - Middle Name:
Other - Last Name:CARDENTEY BORROTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:631 NW 177TH ST APT 108
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6939
Mailing Address - Country:US
Mailing Address - Phone:305-764-5229
Mailing Address - Fax:
Practice Address - Street 1:631 NW 177TH ST APT 108
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-6939
Practice Address - Country:US
Practice Address - Phone:305-764-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLC635060988210106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician