Provider Demographics
NPI:1760961239
Name:PACHECO, DANAE K (BA)
Entity Type:Individual
Prefix:
First Name:DANAE
Middle Name:K
Last Name:PACHECO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 SW 34TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2717
Mailing Address - Country:US
Mailing Address - Phone:305-987-1018
Mailing Address - Fax:
Practice Address - Street 1:2615 SW 34TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2717
Practice Address - Country:US
Practice Address - Phone:305-987-1018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2021-12-01
Deactivation Date:2021-09-27
Deactivation Code:
Reactivation Date:2021-12-01
Provider Licenses
StateLicense IDTaxonomies
FL16-26359106S00000X
FL1-21-48329103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty