Provider Demographics
NPI:1093348344
Name:TREJO, JENNIFER D (RBT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:D
Last Name:TREJO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 N COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1728
Mailing Address - Country:US
Mailing Address - Phone:786-768-6558
Mailing Address - Fax:
Practice Address - Street 1:7789 NW 146TH ST STE B
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1567
Practice Address - Country:US
Practice Address - Phone:954-990-9800
Practice Address - Fax:305-907-5322
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-111769106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty