Provider Demographics
NPI:1023863719
Name:MELENDEZ NORIEGA, JORGE Y (MA)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:Y
Last Name:MELENDEZ NORIEGA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 BOGGY CREEK RD LOT Q10
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9246
Mailing Address - Country:US
Mailing Address - Phone:787-590-7285
Mailing Address - Fax:
Practice Address - Street 1:390 CROWN OAK CENTRE DR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6149
Practice Address - Country:US
Practice Address - Phone:787-590-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT4092106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist