Provider Demographics
NPI:1487457016
Name:VALDERRAMA, SUSSET MARIA
Entity type:Individual
Prefix:
First Name:SUSSET
Middle Name:MARIA
Last Name:VALDERRAMA
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 1:18393 NW 76TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2936
Mailing Address - Country:US
Mailing Address - Phone:786-817-1195
Mailing Address - Fax:
Practice Address - Street 1:124 SE 1ST RD # A
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-7357
Practice Address - Country:US
Practice Address - Phone:786-255-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-422092106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician