Provider Demographics
NPI:1700257458
Name:CASANOVA, YANEL A DE MIRANDA (M,AE, EDS)
Entity type:Individual
Prefix:
First Name:YANEL
Middle Name:A DE MIRANDA
Last Name:CASANOVA
Suffix:
Gender:F
Credentials:M,AE, EDS
Other - Prefix:
Other - First Name:YANEL
Other - Middle Name:ANGELY
Other - Last Name:DE MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5664 SW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5677
Mailing Address - Country:US
Mailing Address - Phone:352-291-5555
Mailing Address - Fax:352-291-5587
Practice Address - Street 1:3238 S LECANTO HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9025
Practice Address - Country:US
Practice Address - Phone:352-628-5020
Practice Address - Fax:352-628-2016
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health