Provider Demographics
NPI:1629568050
Name:VERVER, SOQUEL BREANNE
Entity Type:Individual
Prefix:
First Name:SOQUEL
Middle Name:BREANNE
Last Name:VERVER
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 1:708 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-4814
Mailing Address - Country:US
Mailing Address - Phone:209-614-1117
Mailing Address - Fax:
Practice Address - Street 1:708 PINE ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4814
Practice Address - Country:US
Practice Address - Phone:209-614-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst