Provider Demographics
NPI:1861258691
Name:ALBA TREJO, KENSY LIZETH
Entity type:Individual
Prefix:
First Name:KENSY
Middle Name:LIZETH
Last Name:ALBA TREJO
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 1:1750 NE 191ST ST APT D118
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4284
Mailing Address - Country:US
Mailing Address - Phone:786-562-9590
Mailing Address - Fax:
Practice Address - Street 1:1750 NE 191ST ST APT D118
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-4284
Practice Address - Country:US
Practice Address - Phone:786-562-9590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-318584106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician