Healthcare Provider Details

I. General information

NPI: 1689270944
Provider Name (Legal Business Name): VIRGINIA BAEZ GADDIS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4154 SW 66TH WAY
DAVIE FL
33314-3344
US

IV. Provider business mailing address

2875 NW 82ND AVE STE 103
DORAL FL
33122-1064
US

V. Phone/Fax

Practice location:
  • Phone: 305-776-7372
  • Fax:
Mailing address:
  • Phone: 305-209-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18216
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: