Provider Demographics
NPI:1578855391
Name:DE CARDENAS, JEANNETTE (LMT, RBT)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:DE CARDENAS
Suffix:
Gender:
Credentials:LMT, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7743 SW 86TH ST # D231
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7285
Mailing Address - Country:US
Mailing Address - Phone:786-218-5566
Mailing Address - Fax:
Practice Address - Street 1:7743 SW 86TH ST # D231
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7285
Practice Address - Country:US
Practice Address - Phone:786-218-5566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA61820225700000X
FLRBT-18-70078106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist