Provider Demographics
NPI:1639958382
Name:TOLEDO, VANESA (BS, MA)
Entity type:Individual
Prefix:
First Name:VANESA
Middle Name:
Last Name:TOLEDO
Suffix:
Gender:F
Credentials:BS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15924 SW 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1842
Mailing Address - Country:US
Mailing Address - Phone:059-645-8243
Mailing Address - Fax:786-452-1200
Practice Address - Street 1:1610 N 67TH TER
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5701
Practice Address - Country:US
Practice Address - Phone:754-215-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW211081041C0700X
103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service