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NPI Code Detail

MEDICARE: DEHVANN BERRIOS RBT

MEDICARE: DEHVANN BERRIOS RBT
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1164090056
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEHVANN BERRIOS RBT
Provider Business Mailing Address
First Line : 1831 GOLDEN EAGLE WAY STE 34
Second Line :
City : FLEMING ISLAND
State : FL
Zip : 32003-4340
Country : US
Telephone Number : 904-579-4779
Fax Number :
Provider Business Practice Location Address
First Line : 1831 GOLDEN EAGLE WAY STE 34
Second Line :
City : FLEMING ISLAND
State : FL
Zip : 32003-4340
Country : US
Telephone Number : 904-579-4779
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2021
Last Update Date : 06/16/2021

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Directions to “ DEHVANN BERRIOS RBT” Practice Location

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