Provider Demographics
NPI:1003607714
Name:DORE, VANESSA (BACB1156968)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DORE
Suffix:
Gender:F
Credentials:BACB1156968
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 SW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3912
Mailing Address - Country:US
Mailing Address - Phone:786-527-4597
Mailing Address - Fax:
Practice Address - Street 1:8415 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2305
Practice Address - Country:US
Practice Address - Phone:305-262-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1156968103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst