Provider Demographics
NPI:1548145923
Name:MORENO PATINO, ANDRES JOSE (RBT)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:JOSE
Last Name:MORENO PATINO
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:MRS
Other - First Name:ARYANNA
Other - Middle Name:JOYCE
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:305 WAYMONT CT STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 WAYMONT CT STE 101
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3566
Practice Address - Country:US
Practice Address - Phone:321-316-3823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician