Provider Demographics
NPI:1578120945
Name:CACERES, PATRICIA JEANETH
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEANETH
Last Name:CACERES
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 1:7521 NORMANDY ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3651
Mailing Address - Country:US
Mailing Address - Phone:954-200-4179
Mailing Address - Fax:
Practice Address - Street 1:7521 NORMANDY ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3651
Practice Address - Country:US
Practice Address - Phone:954-200-4179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1982282106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician