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General NPI Number Information
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NPI Number | 1184195794
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Entity Type | Organization
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Legal Business Name | JESSICA L VERA PHD LLC
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Dates
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Enumeration Date | 12/07/2018
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 1451 W CYPRESS CREEK RD STE 300
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City | FT LAUDERDALE
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State | FL
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Zip | 33309-1953
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Country | US
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Telephone | 954-665-0319
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Fax |
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Provider Business Mailing Address
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Address Line | 9832 GRAND VERDE WAY APT 203
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City | BOCA RATON
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State | FL
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Zip | 33428-3519
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Country | US
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Telephone | 954-665-0319
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSICA VERA
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Credential | PHD
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Telephone | 954-665-0319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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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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