Provider Demographics
NPI:1700644572
Name:MORISSEAU, ANIA RENEE
Entity Type:Individual
Prefix:
First Name:ANIA
Middle Name:RENEE
Last Name:MORISSEAU
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 1:961 NE 152ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33162-5811
Mailing Address - Country:US
Mailing Address - Phone:904-716-1051
Mailing Address - Fax:
Practice Address - Street 1:17121 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2008
Practice Address - Country:US
Practice Address - Phone:305-952-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-332031106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician