Provider Demographics
NPI:1700247707
Name:HINCAPIE, JORGE (MS)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:HINCAPIE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 NW 56TH DR APT 115
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3127
Mailing Address - Country:US
Mailing Address - Phone:786-389-7343
Mailing Address - Fax:
Practice Address - Street 1:4110 DAVIE ROAD EXT
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-1679
Practice Address - Country:US
Practice Address - Phone:786-389-7343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15955101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty