Provider Demographics
NPI:1679026041
Name:VERDASCO, LIANETT
Entity Type:Individual
Prefix:
First Name:LIANETT
Middle Name:
Last Name:VERDASCO
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 1:10358 NW 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-1014
Mailing Address - Country:US
Mailing Address - Phone:786-547-2411
Mailing Address - Fax:
Practice Address - Street 1:10358 NW 35TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-1014
Practice Address - Country:US
Practice Address - Phone:786-547-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician