Provider Demographics
NPI:1790378479
Name:VICTOR-TERNIER, MANUELA (RSCW)
Entity Type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:VICTOR-TERNIER
Suffix:
Gender:F
Credentials:RSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9121 NW 18TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3204
Mailing Address - Country:US
Mailing Address - Phone:305-308-0391
Mailing Address - Fax:
Practice Address - Street 1:9121 NW 18TH CT
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3204
Practice Address - Country:US
Practice Address - Phone:305-308-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW12295104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker