Provider Demographics
NPI:1376229682
Name:MORALES, JENNIFER GOMEZ (EDS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GOMEZ
Last Name:MORALES
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 SW 81ST LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6687
Mailing Address - Country:US
Mailing Address - Phone:786-344-1779
Mailing Address - Fax:
Practice Address - Street 1:7301 SW 57TH CT STE 565
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5334
Practice Address - Country:US
Practice Address - Phone:786-344-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS934103TS0200X
FLMH21497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool