MEDICARE: MR. JAIME TRAVIESO INCLAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	CBHCMS0102799	FL
2	106S00000X	Behavior Technician	RBT-24-328358	FL

General Provider Information

NPI Number	:	1114433661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAIME TRAVIESO INCLAN

Provider Business Mailing Address
First Line	:	2151 45TH ST STE 202
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2009
Country	:	US
Telephone Number	:	561-823-8250
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 45TH ST STE 202
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2009
Country	:	US
Telephone Number	:	561-823-8250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2017
Last Update Date	:	12/16/2025

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