Provider Demographics
NPI:1730976937
Name:NEYRA RAOLA, BETINA
Entity type:Individual
Prefix:
First Name:BETINA
Middle Name:
Last Name:NEYRA RAOLA
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 1:2501 NW 16TH STREET RD APT 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1294
Mailing Address - Country:US
Mailing Address - Phone:786-810-5839
Mailing Address - Fax:
Practice Address - Street 1:2501 NW 16TH STREET RD APT 205
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1294
Practice Address - Country:US
Practice Address - Phone:786-810-5839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-416980106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician