=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841015773
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADYANETH HERCE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2024
-----------------------------------------------------
Last Update Date | 02/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 N MILITARY TRL STE 304
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-6324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-421-5111
-----------------------------------------------------
Fax | 561-421-5222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9986 SW CHADWICK DR
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34987-2416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-719-7910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-24-379719
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------