Healthcare Provider Details

I. General information

NPI: 1477099372
Provider Name (Legal Business Name): VALERIA ALEJANDRA MITCHELL RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VALERIA ALEJANDRA LOPEZ

II. Dates (important events)

Enumeration Date: 01/16/2017
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 PINE RIDGE RD
NAPLES FL
34109-6826
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-254-4260
  • Fax: 239-254-4261
Mailing address:
  • Phone: 239-254-4260
  • Fax: 239-254-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-45342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: