Provider Demographics
NPI:1306124094
Name:ALONSO, JEANETTE (MSED, LMHC)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:
Last Name:ALONSO
Suffix:
Gender:F
Credentials:MSED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8036 SW 81ST DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6609
Mailing Address - Country:US
Mailing Address - Phone:305-270-7968
Mailing Address - Fax:305-270-2540
Practice Address - Street 1:8036 SW 81ST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-6609
Practice Address - Country:US
Practice Address - Phone:305-270-7968
Practice Address - Fax:305-270-2540
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10227101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health