Provider Demographics
NPI:1578354353
Name:HERRERA ACOSTA, ILEANA (RBT-25-432481)
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:HERRERA ACOSTA
Suffix:
Gender:F
Credentials:RBT-25-432481
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 PINELLAS POINT DR S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-5423
Mailing Address - Country:US
Mailing Address - Phone:656-224-7526
Mailing Address - Fax:
Practice Address - Street 1:13911 N DALE MABRY HWY STE 108
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2414
Practice Address - Country:US
Practice Address - Phone:813-784-3619
Practice Address - Fax:813-305-7033
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-432481106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician