Provider Demographics
NPI:1386086023
Name:SYMONETTE, WILLIMINIA JANET
Entity type:Individual
Prefix:
First Name:WILLIMINIA
Middle Name:JANET
Last Name:SYMONETTE
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 1:2725 ACAPULCO DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4705
Mailing Address - Country:US
Mailing Address - Phone:786-372-3673
Mailing Address - Fax:
Practice Address - Street 1:2725 ACAPULCO DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-4705
Practice Address - Country:US
Practice Address - Phone:786-372-3673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst