MEDICARE: JESSICA L VERA PHD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1184195794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA L VERA PHD LLC

Provider Business Mailing Address
First Line	:	9832 GRAND VERDE WAY APT 203
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-3519
Country	:	US
Telephone Number	:	954-665-0319
Fax Number	:

Provider Business Practice Location Address
First Line	:	1451 W CYPRESS CREEK RD STE 300
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-1953
Country	:	US
Telephone Number	:	954-665-0319
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JESSICA VERA
Credential	:	PHD
Telephone Number	:	954-665-0319

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	11/28/2023

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