Provider Demographics
NPI:1477260313
Name:JEANJACQUES, VANESSA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:JEANJACQUES
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 1:15705 MIAMI LAKEWAY N APT 212B
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-8119
Mailing Address - Country:US
Mailing Address - Phone:305-332-4838
Mailing Address - Fax:
Practice Address - Street 1:15705 MIAMI LAKEWAY N APT 212B
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-8119
Practice Address - Country:US
Practice Address - Phone:305-332-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW199541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical