Provider Demographics
NPI:1609604693
Name:JARDINES, CINDY R
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:R
Last Name:JARDINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3284 W 70TH ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7168
Mailing Address - Country:US
Mailing Address - Phone:786-626-5709
Mailing Address - Fax:
Practice Address - Street 1:3284 W 70TH ST UNIT 101
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-7168
Practice Address - Country:US
Practice Address - Phone:786-626-5709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-336225106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty