Provider Demographics
NPI:1174393714
Name:DIBUCCI, VANESSA S
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:S
Last Name:DIBUCCI
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 1:900 NW 31ST AVE STE 2000
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-6653
Mailing Address - Country:US
Mailing Address - Phone:954-357-5005
Mailing Address - Fax:954-354-6533
Practice Address - Street 1:325 SW 28TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-2612
Practice Address - Country:US
Practice Address - Phone:954-357-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19329104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker