Healthcare Provider Details

I. General information

NPI: 1558101394
Provider Name (Legal Business Name): VANESSA RADICE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 SW 8TH ST STE 258
MIAMI FL
33144-4000
US

IV. Provider business mailing address

12629 SW 29TH ST
MIRAMAR FL
33027-4112
US

V. Phone/Fax

Practice location:
  • Phone: 305-810-8869
  • Fax:
Mailing address:
  • Phone: 786-344-4768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH14166
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14166
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: