Provider Demographics
NPI:1386189512
Name:ABREU, JORGE HANS
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:HANS
Last Name:ABREU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 NW 111TH PL
Mailing Address - Street 2:8
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3774
Mailing Address - Country:US
Mailing Address - Phone:786-520-9822
Mailing Address - Fax:
Practice Address - Street 1:12880 SW 62ND LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5442
Practice Address - Country:US
Practice Address - Phone:786-520-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-26
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLRBT-18-58174106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst