Provider Demographics
NPI:1033800115
Name:VELOSO MANENT, YANET
Entity Type:Individual
Prefix:
First Name:YANET
Middle Name:
Last Name:VELOSO MANENT
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 1:11921 SW 176TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2346
Mailing Address - Country:US
Mailing Address - Phone:786-231-9095
Mailing Address - Fax:
Practice Address - Street 1:16650 N KENDALL DR STE 210
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1283
Practice Address - Country:US
Practice Address - Phone:305-916-4870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-261434106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician