Provider Demographics
NPI:1013305754
Name:ESTEVEZ, EDNEI
Entity Type:Individual
Prefix:
First Name:EDNEI
Middle Name:
Last Name:ESTEVEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 NW 87TH AVE APT I215
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4563
Mailing Address - Country:US
Mailing Address - Phone:786-343-0813
Mailing Address - Fax:
Practice Address - Street 1:230 NW 87TH AVE APT I215
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4563
Practice Address - Country:US
Practice Address - Phone:786-343-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103K00000X
1-20-41168103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty