Provider Demographics
NPI:1235687369
Name:JEROME, MYRALDA (MS)
Entity Type:Individual
Prefix:
First Name:MYRALDA
Middle Name:
Last Name:JEROME
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10140 BOYNTON PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2657
Mailing Address - Country:US
Mailing Address - Phone:561-908-1336
Mailing Address - Fax:
Practice Address - Street 1:10140 BOYNTON PLACE CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-2657
Practice Address - Country:US
Practice Address - Phone:561-908-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH14209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health