Provider Demographics
NPI:1992206387
Name:IVERSON, DEONDRA
Entity Type:Individual
Prefix:
First Name:DEONDRA
Middle Name:
Last Name:IVERSON
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 1:520 N SEMORAN BLVD STE 280
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3337
Mailing Address - Country:US
Mailing Address - Phone:407-306-9766
Mailing Address - Fax:
Practice Address - Street 1:1655 PALM BEACH LAKES BLVD STE 600
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2208
Practice Address - Country:US
Practice Address - Phone:561-840-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker