Provider Demographics
NPI:1689390353
Name:RANGEL, JACQUELINE (MSED)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:RANGEL
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 CRYSTAL CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-3333
Mailing Address - Country:US
Mailing Address - Phone:717-839-7707
Mailing Address - Fax:
Practice Address - Street 1:3210 CRYSTAL CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-3333
Practice Address - Country:US
Practice Address - Phone:717-839-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health