MEDICARE: JESSICA MIRET

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1811339526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MIRET

Provider Business Mailing Address
First Line	:	6416 NW 5TH WAY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-6112
Country	:	US
Telephone Number	:	888-754-0398
Fax Number	:

Provider Business Practice Location Address
First Line	:	6416 NW 5TH WAY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-6112
Country	:	US
Telephone Number	:	888-754-0398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2013
Last Update Date	:	10/03/2019

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Directions to “ JESSICA MIRET ” Practice Location

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