Provider Demographics
NPI:1477815694
Name:CACERES, DESIREE VARINIA (MSED)
Entity Type:Individual
Prefix:MISS
First Name:DESIREE
Middle Name:VARINIA
Last Name:CACERES
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 MORRIS AVE
Mailing Address - Street 2:6F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-2824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2824 MORRIS AVE
Practice Address - Street 2:6F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-2824
Practice Address - Country:US
Practice Address - Phone:646-756-0876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist