Provider Demographics
NPI:1992677967
Name:PERAZA, MAVELYS
Entity type:Individual
Prefix:
First Name:MAVELYS
Middle Name:
Last Name:PERAZA
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 1:2142 JUDITH CT
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-9265
Mailing Address - Country:US
Mailing Address - Phone:305-742-9716
Mailing Address - Fax:
Practice Address - Street 1:2142 JUDITH CT
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-9265
Practice Address - Country:US
Practice Address - Phone:305-742-9716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-474304106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician