Provider Demographics
NPI:1144943713
Name:PINO, AILYN (RBT-22-225015)
Entity type:Individual
Prefix:
First Name:AILYN
Middle Name:
Last Name:PINO
Suffix:
Gender:F
Credentials:RBT-22-225015
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8477 WINGED FOOT DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-2921
Mailing Address - Country:US
Mailing Address - Phone:239-307-7563
Mailing Address - Fax:
Practice Address - Street 1:3905 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1719
Practice Address - Country:US
Practice Address - Phone:239-848-5560
Practice Address - Fax:855-521-0661
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-225015106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician