Provider Demographics
NPI:1144839663
Name:REYES ROQUE, YOEL (RBT)
Entity type:Individual
Prefix:
First Name:YOEL
Middle Name:
Last Name:REYES ROQUE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 DAIL RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2007
Mailing Address - Country:US
Mailing Address - Phone:863-602-6457
Mailing Address - Fax:
Practice Address - Street 1:4612 DAIL RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2007
Practice Address - Country:US
Practice Address - Phone:863-602-6457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12580051103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst