Provider Demographics
NPI:1023347291
Name:YANEZ, VICENTE SR (SW 4132)
Entity type:Individual
Prefix:MR
First Name:VICENTE
Middle Name:
Last Name:YANEZ
Suffix:SR
Gender:M
Credentials:SW 4132
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE # 418
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3049
Mailing Address - Country:US
Mailing Address - Phone:305-469-1648
Mailing Address - Fax:305-442-1018
Practice Address - Street 1:814 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE # 418
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3049
Practice Address - Country:US
Practice Address - Phone:305-469-1648
Practice Address - Fax:305-442-1018
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 41321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical