Provider Demographics
NPI:1871341354
Name:PEREZ PEREZ, GLENDA (RBT)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:PEREZ PEREZ
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 1:6150 SW 130TH AVE APT 1508
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5232
Mailing Address - Country:US
Mailing Address - Phone:786-710-5828
Mailing Address - Fax:
Practice Address - Street 1:6150 SW 130TH AVE APT 1508
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5232
Practice Address - Country:US
Practice Address - Phone:786-710-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.0106536-P171M00000X
FLRBT-24-333601106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator