Provider Demographics
NPI:1871474973
Name:NOLASCO REYES, YESSICA
Entity type:Individual
Prefix:
First Name:YESSICA
Middle Name:
Last Name:NOLASCO REYES
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 1:2262 DISCOVERY CIR W
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1037
Mailing Address - Country:US
Mailing Address - Phone:561-215-4717
Mailing Address - Fax:
Practice Address - Street 1:2262 DISCOVERY CIR W
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1037
Practice Address - Country:US
Practice Address - Phone:561-215-4717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-467397106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician