Provider Demographics
NPI:1619659869
Name:SAN MILLAN, VANESSA VICTORERO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:VICTORERO
Last Name:SAN MILLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8021 SW 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4142
Mailing Address - Country:US
Mailing Address - Phone:130-581-2944
Mailing Address - Fax:
Practice Address - Street 1:8021 SW 136TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4142
Practice Address - Country:US
Practice Address - Phone:305-812-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW219131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical