Provider Demographics
NPI:1144090945
Name:MARRERO DELGADO, VIVIANNE
Entity type:Individual
Prefix:
First Name:VIVIANNE
Middle Name:
Last Name:MARRERO DELGADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13235 SW 57TH TER APT 1904
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1262
Mailing Address - Country:US
Mailing Address - Phone:786-955-5227
Mailing Address - Fax:
Practice Address - Street 1:13235 SW 57TH TER
Practice Address - Street 2:APT 19 04
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183
Practice Address - Country:US
Practice Address - Phone:786-955-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-312293106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician