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General NPI Number Information
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NPI Number | 1215282058
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Entity Type | Individual
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Provider Name | YESSENIA MARCANO
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Gender | Female
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 14411 COMMERCE WAY STE 310 #214
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City | MIAMI LAKES
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State | FL
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Zip | 33016-1532
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Country | US
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Telephone | 305-827-2822
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Fax | 786-827-2819
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Provider Business Mailing Address
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Address Line | 131 NW 72ND WAY
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-7223
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Country | US
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Telephone | 786-663-6780
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Fax | 786-827-2819
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | FL
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