Provider Demographics
NPI:1215793377
Name:DERAS, CECILIA
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:DERAS
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 1:559 AUTUMN STREAM DR
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-2171
Mailing Address - Country:US
Mailing Address - Phone:787-974-6263
Mailing Address - Fax:
Practice Address - Street 1:559 AUTUMN STREAM DR
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-2171
Practice Address - Country:US
Practice Address - Phone:787-974-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty