Provider Demographics
NPI:1760803969
Name:PIBERNUS, JESSICA E (MA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:PIBERNUS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6429 COW PEN RD APT U108
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6619
Mailing Address - Country:US
Mailing Address - Phone:787-598-6883
Mailing Address - Fax:
Practice Address - Street 1:6429 COW PEN RD APT U108
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6619
Practice Address - Country:US
Practice Address - Phone:787-598-6883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLBACB1455562106S00000X
PR4321103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling