Provider Demographics
NPI:1659040558
Name:CLAVAREZA, JEHREMI RENE (LCSW)
Entity Type:Individual
Prefix:
First Name:JEHREMI
Middle Name:RENE
Last Name:CLAVAREZA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 NW 84TH AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1548
Mailing Address - Country:US
Mailing Address - Phone:305-609-5312
Mailing Address - Fax:
Practice Address - Street 1:2670 NW 84TH AVE APT 105
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1548
Practice Address - Country:US
Practice Address - Phone:305-609-5312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL159441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN21000001650OtherNOT A MDCR PROVIDER AT THIS TIME