Provider Demographics
NPI:1134466154
Name:VALDENEGRO, VANESSA RENEE (BCBA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:RENEE
Last Name:VALDENEGRO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2824
Mailing Address - Country:US
Mailing Address - Phone:305-484-0910
Mailing Address - Fax:
Practice Address - Street 1:1461 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2824
Practice Address - Country:US
Practice Address - Phone:305-484-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-15-20912103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-15-20912OtherAPPLIED BEHAVIOR ANALYSIS (ABA)