Provider Demographics
NPI:1861722787
Name:DEAN, DEENA K (MS)
Entity type:Individual
Prefix:MS
First Name:DEENA
Middle Name:K
Last Name:DEAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 37TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6507
Mailing Address - Country:US
Mailing Address - Phone:772-563-4666
Mailing Address - Fax:772-563-4771
Practice Address - Street 1:1190 37TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6507
Practice Address - Country:US
Practice Address - Phone:772-563-4666
Practice Address - Fax:772-563-4771
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 2706101YM0800X
FLMH2706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health