Provider Demographics
NPI:1356490106
Name:DERIBEAUX, MARIA (CLINICAL SUPERVISOR)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:DERIBEAUX
Suffix:
Gender:F
Credentials:CLINICAL SUPERVISOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8541 SW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2303
Mailing Address - Country:US
Mailing Address - Phone:305-624-7450
Mailing Address - Fax:
Practice Address - Street 1:1825 NW 167TH ST
Practice Address - Street 2:SUITE # 102
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33056-4838
Practice Address - Country:US
Practice Address - Phone:305-624-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 28431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical