Provider Demographics
NPI:1497241954
Name:DATIZ, JENNY RUTH (RMHCI)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:RUTH
Last Name:DATIZ
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 NW 49TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-3646
Mailing Address - Country:US
Mailing Address - Phone:786-975-7194
Mailing Address - Fax:
Practice Address - Street 1:2290 NW 49TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-3646
Practice Address - Country:US
Practice Address - Phone:786-975-7194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health