Provider Demographics
NPI:1841015773
Name:HERCE, ADYANETH
Entity type:Individual
Prefix:
First Name:ADYANETH
Middle Name:
Last Name:HERCE
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 1:9986 SW CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2416
Mailing Address - Country:US
Mailing Address - Phone:786-719-7910
Mailing Address - Fax:
Practice Address - Street 1:2500 N MILITARY TRL STE 304
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6324
Practice Address - Country:US
Practice Address - Phone:561-421-5111
Practice Address - Fax:561-421-5222
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-379719106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106S00000XMedicaid