Healthcare Provider Details

I. General information

NPI: 1306124094
Provider Name (Legal Business Name): JEANETTE ALONSO MS.ED, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8036 SW 81ST DR
MIAMI FL
33143-6609
US

IV. Provider business mailing address

8036 SW 81ST DR
MIAMI FL
33143-6609
US

V. Phone/Fax

Practice location:
  • Phone: 305-270-7968
  • Fax: 305-270-2540
Mailing address:
  • Phone: 305-270-7968
  • Fax: 305-270-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: