Provider Demographics
NPI:1649564212
Name:MENENDEZ FERRERA, JORGE
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:MENENDEZ FERRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JORGE
Other - Middle Name:
Other - Last Name:MENENDEZ FERRERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:27602 SW 134TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8254
Mailing Address - Country:US
Mailing Address - Phone:786-226-2816
Mailing Address - Fax:
Practice Address - Street 1:27602 SW 134TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8254
Practice Address - Country:US
Practice Address - Phone:786-226-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-13-13827103K00000X
FL0-11-4309103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018278500Medicaid