MEDICARE: MISS YESSIRA USECHE PERDIGON III LICSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	171M00000X	Case Manager/Care Coordinator
3	1041C0700X	Clinical Social Worker	ISW20094	FL

General Provider Information

NPI Number	:	1699663450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS YESSIRA USECHE PERDIGON III LICSW

Provider Business Mailing Address
First Line	:	6770 INDIAN CREEK DR APT TSC
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-5709
Country	:	US
Telephone Number	:	786-656-1866
Fax Number	:

Provider Business Practice Location Address
First Line	:	6770 INDIAN CREEK DR APT TSC
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-5709
Country	:	US
Telephone Number	:	786-656-1866
Fax Number	:

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

Provider Enumeration Date	:	06/27/2025
Last Update Date	:	03/06/2026

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