Provider Demographics
NPI:1578648531
Name:VERA, WILFREDO (PHD)
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:VERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 S MIAMI AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4236
Mailing Address - Country:US
Mailing Address - Phone:305-609-2722
Mailing Address - Fax:305-447-9470
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-609-2722
Practice Address - Fax:305-447-9470
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4946103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59480OtherBCBS PROV NUMBER
FLPY4946OtherSTATE LICENSE
FL59480Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER