Provider Demographics
NPI:1043697402
Name:DE JESUS, ADAMAR (ITDS)
Entity Type:Individual
Prefix:
First Name:ADAMAR
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 GARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-6102
Mailing Address - Country:US
Mailing Address - Phone:407-325-8459
Mailing Address - Fax:
Practice Address - Street 1:1944 GARWOOD DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-6102
Practice Address - Country:US
Practice Address - Phone:407-325-8459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4097103TS0200X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool