Provider Demographics
NPI:1033847603
Name:HENRIQUEZ, VERONICA (SSP, LSP, NCSP)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:SSP, LSP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 SE LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4770
Mailing Address - Country:US
Mailing Address - Phone:786-718-2466
Mailing Address - Fax:
Practice Address - Street 1:491 SE LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4770
Practice Address - Country:US
Practice Address - Phone:786-718-2466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1523103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool