Provider Demographics
NPI:1376858738
Name:DEBORA DEJESUS
Entity Type:Organization
Organization Name:DEBORA DEJESUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJESUS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-439-8158
Mailing Address - Street 1:1000 PARK CENTRE BLVD
Mailing Address - Street 2:STE# 138
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5373
Mailing Address - Country:US
Mailing Address - Phone:305-948-9000
Mailing Address - Fax:786-999-0700
Practice Address - Street 1:1000 PARK CENTRE BLVD
Practice Address - Street 2:STE# 138
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-5373
Practice Address - Country:US
Practice Address - Phone:305-948-9000
Practice Address - Fax:786-999-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6847101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty