Provider Demographics
NPI:1164642104
Name:BRICENO, VANESSA (MS)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BRICENO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2933 SE 2ND DR
Mailing Address - Street 2:UNIT 2
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7328
Mailing Address - Country:US
Mailing Address - Phone:305-896-6737
Mailing Address - Fax:
Practice Address - Street 1:2933 SE 2ND DR
Practice Address - Street 2:UNIT 2
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7328
Practice Address - Country:US
Practice Address - Phone:305-896-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health