1477430452 NPI number — CLAVEROS MENTAL WELL-BEING LLC

Table of content: VANESSA MILDRED KEDL LAPC (NPI 1760369763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477430452 NPI number — CLAVEROS MENTAL WELL-BEING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAVEROS MENTAL WELL-BEING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477430452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19835 NW 53RD PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33055-1676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-908-7562
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19835 NW 53RD PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33055-1676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-908-7562
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2025

Additional Information

Authorized Official

Authorized Official Last Name:
CLAVERO
Authorized Official First Name:
VIVIAN
Authorized Official Middle Name:
ISEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
786-908-7562

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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