Provider Demographics
NPI:1548074834
Name:PLACERES VALLEJO, YARAVY
Entity type:Individual
Prefix:
First Name:YARAVY
Middle Name:
Last Name:PLACERES VALLEJO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20850 SW 87TH AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-7405
Mailing Address - Country:US
Mailing Address - Phone:786-707-6254
Mailing Address - Fax:
Practice Address - Street 1:20850 SW 87TH AVE APT 204
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-7405
Practice Address - Country:US
Practice Address - Phone:786-707-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-405044106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty