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NPI Code Detail

MEDICARE: MS. REBECCA JAGGERNAUTH LCSW

MEDICARE: MS. REBECCA JAGGERNAUTH LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YM0800XMental Health CounselorSW15489FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124391313
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. REBECCA JAGGERNAUTH LCSW
Provider Business Mailing Address
First Line : 325 SW 28TH ST
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33315-2612
Country : US
Telephone Number : 954-357-4848
Fax Number :
Provider Business Practice Location Address
First Line : 325 SW 28TH ST
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33315-2612
Country : US
Telephone Number : 954-357-4848
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2012
Last Update Date : 09/20/2021

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