Healthcare Provider Details

I. General information

NPI: 1427603091
Provider Name (Legal Business Name): JENNIFER URBAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 07/04/2020
Certification Date: 07/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 W 77TH ST
HIALEAH FL
33014-4205
US

IV. Provider business mailing address

441 W 77TH ST
HIALEAH FL
33014-4205
US

V. Phone/Fax

Practice location:
  • Phone: 305-308-9941
  • Fax:
Mailing address:
  • Phone: 305-308-9941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: