Healthcare Provider Details

I. General information

NPI: 1386429538
Provider Name (Legal Business Name): HECTOR REYNALDO BODE-MARRERO RMHCI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44177 KELLY DR
BABCOCK RANCH FL
33982-5372
US

IV. Provider business mailing address

4248 18TH PL SW
NAPLES FL
34116-5916
US

V. Phone/Fax

Practice location:
  • Phone: 239-427-1635
  • Fax: 717-789-1914
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: