Provider Demographics
NPI:1306401286
Name:PICANOL, JAIME RAUL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:RAUL
Last Name:PICANOL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4128 NE 30TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5178
Mailing Address - Country:US
Mailing Address - Phone:305-331-6011
Mailing Address - Fax:305-242-5526
Practice Address - Street 1:9370 SUNSET DR STE A213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5452
Practice Address - Country:US
Practice Address - Phone:305-331-6011
Practice Address - Fax:305-242-5526
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9057103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic