Provider Demographics
NPI:1437365905
Name:ESTRADA, JEANNETTE FATIMA (MENTAL HEALTH COUNS)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:FATIMA
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:MENTAL HEALTH COUNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9536 SW 20TERR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165
Mailing Address - Country:US
Mailing Address - Phone:305-551-2968
Mailing Address - Fax:
Practice Address - Street 1:2810 NW SOUTH RIVER DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1120
Practice Address - Country:US
Practice Address - Phone:305-636-3501
Practice Address - Fax:305-636-3539
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH4020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health