Provider Demographics
NPI:1073405924
Name:PALMA AMAYA, JACKENIA M
Entity type:Individual
Prefix:
First Name:JACKENIA
Middle Name:M
Last Name:PALMA AMAYA
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 1:3399 NW 100TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-1946
Mailing Address - Country:US
Mailing Address - Phone:765-469-6499
Mailing Address - Fax:
Practice Address - Street 1:3399 NW 100TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-1946
Practice Address - Country:US
Practice Address - Phone:765-469-6499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25-452961106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician