Provider Demographics
NPI:1093079576
Name:STREIMER, JAY
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:STREIMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 SW 107TH WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2164
Mailing Address - Country:US
Mailing Address - Phone:954-476-0200
Mailing Address - Fax:954-476-0200
Practice Address - Street 1:4400 SW 107TH WAY
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2164
Practice Address - Country:US
Practice Address - Phone:954-476-0200
Practice Address - Fax:954-476-0200
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3229101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health