Provider Demographics
NPI:1518679778
Name:CANDELARIO, VENESSA
Entity Type:Individual
Prefix:
First Name:VENESSA
Middle Name:
Last Name:CANDELARIO
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 1:2083 VELVET LEAF DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4883
Mailing Address - Country:US
Mailing Address - Phone:321-948-2343
Mailing Address - Fax:
Practice Address - Street 1:730 9TH ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4024
Practice Address - Country:US
Practice Address - Phone:407-914-7790
Practice Address - Fax:407-395-8654
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-245641106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician