MEDICARE: YESSENIA MARCANO

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	104100000X	Social Worker
2	106S00000X	Behavior Technician
3	171M00000X	Case Manager/Care Coordinator	FL

General Provider Information

NPI Number	:	1215282058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YESSENIA MARCANO

Provider Business Mailing Address
First Line	:	131 NW 72ND WAY
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-7223
Country	:	US
Telephone Number	:	786-663-6780
Fax Number	:	786-827-2819

Provider Business Practice Location Address
First Line	:	14411 COMMERCE WAY STE 310
Second Line	:	#214
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-1532
Country	:	US
Telephone Number	:	305-827-2822
Fax Number	:	786-827-2819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	03/26/2021

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Directions to “ YESSENIA MARCANO ” Practice Location

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