Provider Demographics
NPI:1710675012
Name:PINEDA, VIDA MARIEL
Entity Type:Individual
Prefix:
First Name:VIDA
Middle Name:MARIEL
Last Name:PINEDA
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 1:534 GREEN SPRINGS PL
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-7509
Mailing Address - Country:US
Mailing Address - Phone:646-266-7077
Mailing Address - Fax:
Practice Address - Street 1:534 GREEN SPRINGS PL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-7509
Practice Address - Country:US
Practice Address - Phone:646-266-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW17647104100000X
NY111265-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker