Provider Demographics
NPI:1356232532
Name:SOSA, JENIFER MARIA
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:MARIA
Last Name:SOSA
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 1:4480 NW 172ND DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4345
Mailing Address - Country:US
Mailing Address - Phone:786-669-7136
Mailing Address - Fax:
Practice Address - Street 1:4480 NW 172ND DR
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-4345
Practice Address - Country:US
Practice Address - Phone:786-669-7136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-424-226106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician