MEDICARE: JESSICA E PIBERNUS M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	4321	PR
2	222Q00000X	Developmental Therapist
3	106S00000X	Behavior Technician	BACB1455562	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760803969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA E PIBERNUS M.A.

Provider Business Mailing Address
First Line	:	6429 COW PEN RD APT U108
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-6619
Country	:	US
Telephone Number	:	787-598-6883
Fax Number	:

Provider Business Practice Location Address
First Line	:	6429 COW PEN RD APT U108
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-6619
Country	:	US
Telephone Number	:	787-598-6883
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	01/21/2026

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