Provider Demographics
NPI:1922863091
Name:DETRES, VASHTI (MSW)
Entity Type:Individual
Prefix:
First Name:VASHTI
Middle Name:
Last Name:DETRES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 NE 14TH DR
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5912
Mailing Address - Country:US
Mailing Address - Phone:305-281-0642
Mailing Address - Fax:
Practice Address - Street 1:4040 NE 14TH DR
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5912
Practice Address - Country:US
Practice Address - Phone:305-281-0642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker