Healthcare Provider Details

I. General information

NPI: 1720590979
Provider Name (Legal Business Name): MARIA LETICIA VERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 STIRLING RD STE 204
FORT LAUDERDALE FL
33312-6547
US

IV. Provider business mailing address

3113 STIRLING RD STE 204
FORT LAUDERDALE FL
33312-6547
US

V. Phone/Fax

Practice location:
  • Phone: 954-842-3501
  • Fax: 954-206-0906
Mailing address:
  • Phone: 954-842-3501
  • Fax: 954-206-0906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: