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General NPI Number Information
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NPI Number | 1750575866
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Entity Type | Individual
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Provider Name | AMINA LINETTE JEREZ MS
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Gender | Female
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | 9299 SW 152ND ST SUITE # 200
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City | PALMETTO BAY
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State | FL
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Zip | 33157-1737
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Country | US
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Telephone | 786-601-2608
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Fax | 305-647-0250
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Provider Business Mailing Address
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Address Line | PO BOX 700731
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City | MIAMI
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State | FL
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Zip | 33170-0731
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Country | US
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Telephone | 786-601-7243
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Fax | 786-349-5302
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH 5894
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License Number State | FL
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