Provider Demographics
NPI:1760612733
Name:VERA, BRENDA IRIS (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:IRIS
Last Name:VERA
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 142845
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-2845
Mailing Address - Country:US
Mailing Address - Phone:787-878-5338
Mailing Address - Fax:
Practice Address - Street 1:CARR. #2 KM 81.1
Practice Address - Street 2:SECTOR SAN DANIEL
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-403-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3354103TC0700X
PR4895104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker