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General NPI Number Information
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NPI Number | 1093609364
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Entity Type | Organization
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Legal Business Name | VIDASERENE COUNSELING, LLC
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 410 AVE MONTE SOL STE 14 #2020
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City | FAJARDO
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State | PR
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Zip | 00738-5102
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Country | US
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Telephone | 872-225-0531
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Fax |
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Provider Business Mailing Address
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Address Line | 410 AVE MONTE SOL STE 14
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City | FAJARDO
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State | PR
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Zip | 00738-5102
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Country | US
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Telephone | 872-225-0531
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CLINICAL THERAPIST
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Name | JENNIFER MIRANDA
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Credential | LCPC, LMHC, CMHC
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Telephone | 941-799-1383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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