Provider Demographics
NPI:1396731378
Name:SIERRA, JOSE JAVIER (PSYD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:JAVIER
Last Name:SIERRA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 VALENCIA COLLEGE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3246
Mailing Address - Country:US
Mailing Address - Phone:407-482-7500
Mailing Address - Fax:407-482-7575
Practice Address - Street 1:8530 SUBURBAN DR.
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825
Practice Address - Country:US
Practice Address - Phone:407-482-7500
Practice Address - Fax:407-482-7575
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9319101YM0800X
IL180005069101YP2500X
FLMT 2284106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364333972OtherTAX IDENTIFICATION NO.