Provider Demographics
NPI:1194038992
Name:CACERES, WANDY (BCABA)
Entity Type:Individual
Prefix:MR
First Name:WANDY
Middle Name:
Last Name:CACERES
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16401 SW 72ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3700
Mailing Address - Country:US
Mailing Address - Phone:786-597-2047
Mailing Address - Fax:
Practice Address - Street 1:16401 SW 72ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3700
Practice Address - Country:US
Practice Address - Phone:786-597-2047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst