Provider Demographics
NPI:1093222705
Name:VERDECIA, GLENDA O
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:O
Last Name:VERDECIA
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 1:14437 SW 280TH ST APT 103
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8411
Mailing Address - Country:US
Mailing Address - Phone:305-587-6194
Mailing Address - Fax:
Practice Address - Street 1:14437 SW 280TH ST APT 103
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8411
Practice Address - Country:US
Practice Address - Phone:305-587-6194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician