Provider Demographics
NPI:1457878647
Name:JERRIDO, ANTHONY WILLIAM (MS, CAP)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:WILLIAM
Last Name:JERRIDO
Suffix:
Gender:M
Credentials:MS, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11070 SW 25TH CT APT 10201
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7664
Mailing Address - Country:US
Mailing Address - Phone:786-222-5363
Mailing Address - Fax:
Practice Address - Street 1:11070 SW 25TH CT APT 10201
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7664
Practice Address - Country:US
Practice Address - Phone:786-222-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH13092101YM0800X
FL2486101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty