Provider Demographics
NPI:1376369322
Name:RODRIGUEZ ACOSTA, EYLEE
Entity type:Individual
Prefix:
First Name:EYLEE
Middle Name:
Last Name:RODRIGUEZ ACOSTA
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 1:6720 S FLORIDA AVE APT 3206
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3340
Mailing Address - Country:US
Mailing Address - Phone:813-539-6509
Mailing Address - Fax:
Practice Address - Street 1:2019 E EDGEWOOD DR STE 130
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3667
Practice Address - Country:US
Practice Address - Phone:813-655-8159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB972553103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst