Provider Demographics
NPI:1194332254
Name:ANDERSON-ALVAREZ, VANESSA ILEANN (BS, BCABA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ILEANN
Last Name:ANDERSON-ALVAREZ
Suffix:
Gender:
Credentials:BS, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 BLUE MAGNOLIA RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4029
Mailing Address - Country:US
Mailing Address - Phone:813-847-8179
Mailing Address - Fax:
Practice Address - Street 1:4518 S MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2306
Practice Address - Country:US
Practice Address - Phone:813-847-8179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-134237106S00000X
FL0-25-15914106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty