Provider Demographics
NPI:1174147821
Name:JEREZ MORALES, NADIENKA LUISA (BCBA)
Entity type:Individual
Prefix:
First Name:NADIENKA
Middle Name:LUISA
Last Name:JEREZ MORALES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15660 SW 82ND CIRCLE LN APT 64
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5043
Mailing Address - Country:US
Mailing Address - Phone:786-339-5243
Mailing Address - Fax:
Practice Address - Street 1:15660 SW 82ND CIRCLE LN APT 64
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5043
Practice Address - Country:US
Practice Address - Phone:786-339-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-42096103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst