Provider Demographics
NPI:1962087221
Name:MORENO RAAD, YIVENNE (CBHCM)
Entity type:Individual
Prefix:
First Name:YIVENNE
Middle Name:
Last Name:MORENO RAAD
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 PINES BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6415
Mailing Address - Country:US
Mailing Address - Phone:954-744-4182
Mailing Address - Fax:
Practice Address - Street 1:9050 PINES BLVD STE 205
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6415
Practice Address - Country:US
Practice Address - Phone:954-744-4182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM101267171M00000X
FLCBHCMS0101169104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator