Provider Demographics
NPI:1568963288
Name:ACERO, VANESSA MARIE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:ACERO
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 1:28240 AGOURA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2468
Mailing Address - Country:US
Mailing Address - Phone:805-272-8556
Mailing Address - Fax:805-640-1037
Practice Address - Street 1:893 PATRIOT DR STE A
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3357
Practice Address - Country:US
Practice Address - Phone:818-203-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
14671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program