Provider Demographics
NPI:1013704766
Name:CASTILLO PEREIRA, JENNY BEATRIZ
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:BEATRIZ
Last Name:CASTILLO PEREIRA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15500 SW 12TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2705
Mailing Address - Country:US
Mailing Address - Phone:305-859-3592
Mailing Address - Fax:
Practice Address - Street 1:15500 SW 12TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2705
Practice Address - Country:US
Practice Address - Phone:305-859-3592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-415182106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician