Provider Demographics
NPI:1881913267
Name:SERON, VANESSA (CBA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:SERON
Suffix:
Gender:F
Credentials:CBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 SW 93RD AVE TRLR 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-6548
Mailing Address - Country:US
Mailing Address - Phone:305-812-4610
Mailing Address - Fax:
Practice Address - Street 1:5555 SW 93RD AVE TRLR 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-6548
Practice Address - Country:US
Practice Address - Phone:305-812-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW137991041C0700X
FL1084513103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003033500Medicaid