Provider Demographics
NPI:1831749605
Name:AMAT, AILEEN
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:AMAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20810 SW 87TH AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3926
Mailing Address - Country:US
Mailing Address - Phone:786-491-3081
Mailing Address - Fax:
Practice Address - Street 1:9415 SW 72ND ST STE 131
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5492
Practice Address - Country:US
Practice Address - Phone:305-662-6448
Practice Address - Fax:305-662-6448
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-200393106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician