Provider Demographics
NPI:1548092356
Name:JARA SOTOMAYOR, ANNIE GYULIANE (RCSWI)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:GYULIANE
Last Name:JARA SOTOMAYOR
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 NE 141ST ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-3126
Mailing Address - Country:US
Mailing Address - Phone:786-546-9108
Mailing Address - Fax:
Practice Address - Street 1:437 NE 141ST ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-3126
Practice Address - Country:US
Practice Address - Phone:786-546-9108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW184901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical