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General NPI Number Information
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NPI Number | 1760803969
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Entity Type | Individual
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Provider Name | JESSICA E PIBERNUS M.A.
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Gender | Female
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 6429 COW PEN RD APT U108
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6619
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Country | US
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Telephone | 787-598-6883
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Fax |
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Provider Business Mailing Address
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Address Line | 6429 COW PEN RD APT U108
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6619
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Country | US
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Telephone | 787-598-6883
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Fax |
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB1455562
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 4321
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License Number State | PR
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