Provider Demographics
NPI:1003331646
Name:JUBIZ, NORELLA S (PHD)
Entity type:Individual
Prefix:
First Name:NORELLA
Middle Name:S
Last Name:JUBIZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SE 15TH RD APT 3H
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1202
Mailing Address - Country:US
Mailing Address - Phone:786-378-1745
Mailing Address - Fax:
Practice Address - Street 1:2103 CORAL WAY STE 405
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2630
Practice Address - Country:US
Practice Address - Phone:305-445-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9540103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty