Provider Demographics
NPI:1003552423
Name:NEGRIN, JESSICA RAMONA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAMONA
Last Name:NEGRIN
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 1:4550 W 16TH AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2904
Mailing Address - Country:US
Mailing Address - Phone:561-814-9660
Mailing Address - Fax:
Practice Address - Street 1:4550 W 16TH AVE APT 207
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2904
Practice Address - Country:US
Practice Address - Phone:561-814-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-142736106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician