Provider Demographics
NPI:1659060341
Name:VALIDO, JENNIFER DE LA MERCEDES
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DE LA MERCEDES
Last Name:VALIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30071 SW 147TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3812
Mailing Address - Country:US
Mailing Address - Phone:305-834-6686
Mailing Address - Fax:
Practice Address - Street 1:30071 SW 147TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3812
Practice Address - Country:US
Practice Address - Phone:305-834-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-272441106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician