Healthcare Provider Details

I. General information

NPI: 1376229682
Provider Name (Legal Business Name): JENNIFER GOMEZ MORALES ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 SW 57TH CT STE 565
SOUTH MIAMI FL
33143-5334
US

IV. Provider business mailing address

8600 SW 81ST LN
MIAMI FL
33143-6687
US

V. Phone/Fax

Practice location:
  • Phone: 786-344-1779
  • Fax:
Mailing address:
  • Phone: 786-344-1779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS934
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21497
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: