Provider Demographics
NPI:1629568068
Name:FUMERO DURAN, DANETT
Entity Type:Individual
Prefix:
First Name:DANETT
Middle Name:
Last Name:FUMERO DURAN
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 1:1828 RAMSEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-5724
Mailing Address - Country:US
Mailing Address - Phone:561-808-9011
Mailing Address - Fax:
Practice Address - Street 1:1828 RAMSEY DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33461-5724
Practice Address - Country:US
Practice Address - Phone:561-808-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-68316106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician