Provider Demographics
NPI:1871200337
Name:PENALVER AVILES, YANELA (RBT)
Entity type:Individual
Prefix:
First Name:YANELA
Middle Name:
Last Name:PENALVER AVILES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 BANYAN CANAL DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-2781
Mailing Address - Country:US
Mailing Address - Phone:561-888-7505
Mailing Address - Fax:
Practice Address - Street 1:764 BANYAN CANAL DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-2781
Practice Address - Country:US
Practice Address - Phone:561-888-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-242333106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-22-242333Medicaid