Provider Demographics
NPI:1831997394
Name:HERNANDEZ, MONTYVELL M (RBT)
Entity type:Individual
Prefix:MR
First Name:MONTYVELL
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:MR
Other - First Name:MONTY
Other - Middle Name:M
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:300 INTERNATIONAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5028
Mailing Address - Country:US
Mailing Address - Phone:866-610-0580
Mailing Address - Fax:
Practice Address - Street 1:296 MERCHANTS SQ
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-5029
Practice Address - Country:US
Practice Address - Phone:470-391-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRBT-25-403128106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician