Provider Demographics
NPI:1568185148
Name:PURRINOS, JACQUELINE GENER (PSYD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:GENER
Last Name:PURRINOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14902 SW 23RD WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5882
Mailing Address - Country:US
Mailing Address - Phone:305-301-2768
Mailing Address - Fax:
Practice Address - Street 1:14902 SW 23RD WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5882
Practice Address - Country:US
Practice Address - Phone:305-510-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11624103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical