Samir Gustavo Jerez, LMHC, QS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH5950 Issued in FL

Practice address

11855 SW 216TH St
Miami, FL 33170-2945

Phone

(786) 601-2608

Fax

(305) 647-0250

NPI assigned

Aug 5, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bio-Behavioral Corp.

  dba Go 2 Help Network

  • Behavior Analyst
  • Miami, FL
  • NPI 1457396574

  Mental Health

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686528000000",
    "number": "1912916289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 700731",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331700731",
            "telephone_number": "305-431-8534",
            "fax_number": "305-647-0250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11855 SW 216TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331702945",
            "telephone_number": "786-601-2608",
            "fax_number": "305-647-0250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEREZ",
        "first_name": "SAMIR",
        "middle_name": "GUSTAVO",
        "credential": "LMHC, QS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH5950",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "MH5950",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007140600",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018278700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenia Jerez Martinez
• Nadienka Luisa Jerez Morales, BCBA
• Alvaro J Jerez, M.D
• Dianelys Jerez
• Julia Jerez
• Tatiana Jerez
• Sarah Crissey Jernigan, MD
• Jerome Hernandez, OD, Inc. (Kendall Optical Center)
• Jerome Siegmeister MD PA
• Suzie Jerome-Leacock, ARNP

• Mental Health Counselor in Miami, FL
• Providers in Miami, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.