Provider Demographics
NPI:1902651565
Name:COTILLA, ANISLEIDYS DE LA CARIDAD (RBT)
Entity Type:Individual
Prefix:
First Name:ANISLEIDYS
Middle Name:DE LA CARIDAD
Last Name:COTILLA
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 1:15740 NW 17TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33054-2106
Mailing Address - Country:US
Mailing Address - Phone:786-209-9080
Mailing Address - Fax:
Practice Address - Street 1:15740 NW 17TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33054-2106
Practice Address - Country:US
Practice Address - Phone:786-209-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-333790106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician