Healthcare Provider Details

I. General information

NPI: 1144556986
Provider Name (Legal Business Name): MRS. JANERA ECHEVARRIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S SEMORAN BLVD STE A
ORLANDO FL
32807-1424
US

IV. Provider business mailing address

15031 PERDIDO DR
ORLANDO FL
32828-5216
US

V. Phone/Fax

Practice location:
  • Phone: 407-702-5258
  • Fax: 407-382-0659
Mailing address:
  • Phone: 407-702-5258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH10628
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCABA 0-05-1761
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10628
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: