Provider Demographics
NPI:1588198568
Name:CEBALLOS, VERONICA ISABEL (MHI)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ISABEL
Last Name:CEBALLOS
Suffix:
Gender:F
Credentials:MHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12981 SW 135TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7015
Mailing Address - Country:US
Mailing Address - Phone:786-580-6688
Mailing Address - Fax:786-536-9833
Practice Address - Street 1:12981 SW 135TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7015
Practice Address - Country:US
Practice Address - Phone:786-580-6688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FLIMH17099101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical