Provider Demographics
NPI:1407639867
Name:CACERES, VIVIANA (BSP)
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:
Last Name:CACERES
Suffix:
Gender:F
Credentials:BSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 E SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2826
Mailing Address - Country:US
Mailing Address - Phone:754-400-0089
Mailing Address - Fax:
Practice Address - Street 1:6299 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6180
Practice Address - Country:US
Practice Address - Phone:954-533-8678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health