Provider Demographics
NPI:1952031080
Name:VAN DIERMEN, VICKY CHARLOTTE
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:CHARLOTTE
Last Name:VAN DIERMEN
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 1:300 E OAKLAND PARK BLVD STE 341
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-2148
Mailing Address - Country:US
Mailing Address - Phone:954-247-1674
Mailing Address - Fax:
Practice Address - Street 1:3236 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7368
Practice Address - Country:US
Practice Address - Phone:954-294-2852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst