Individual
BERAN D MICLISSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
567 NW LAKE WHITNEY PL, PORT ST LUCIE, FL 34986-1629
(772) 337-8164
Mailing address
4570 PORTOFINO WAY APT 207, WEST PALM BEACH, FL 33409-8108
(347) 652-9745
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/12/2022
Last updated
09/12/2022
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