Provider Demographics
NPI:1750575866
Name:JEREZ, AMINA LINETTE (MS)
Entity type:Individual
Prefix:
First Name:AMINA
Middle Name:LINETTE
Last Name:JEREZ
Suffix:
Gender:F
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:PO BOX 700731
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-0731
Mailing Address - Country:US
Mailing Address - Phone:786-601-7243
Mailing Address - Fax:786-349-5302
Practice Address - Street 1:9299 SW 152ND ST
Practice Address - Street 2:SUITE # 200
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1737
Practice Address - Country:US
Practice Address - Phone:786-601-2608
Practice Address - Fax:305-647-0250
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLIMH 5894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor