Provider Demographics
NPI:1346759859
Name:VERA, EMMA
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:VERA
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 1:8550 SW 149TH AVE APT 705
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1449
Mailing Address - Country:US
Mailing Address - Phone:786-355-3079
Mailing Address - Fax:772-237-1962
Practice Address - Street 1:8550 SW 149TH AVE APT 705
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1449
Practice Address - Country:US
Practice Address - Phone:786-355-3079
Practice Address - Fax:772-237-1962
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2022-02-23
Deactivation Date:2022-01-06
Deactivation Code:
Reactivation Date:2022-01-17
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-21-56903103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician