Healthcare Provider Details

I. General information

NPI: 1689884777
Provider Name (Legal Business Name): SEAN P. JENNINGS, PSY.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ROBIN RD STE 2006
ALTAMONTE SPRINGS FL
32701-5035
US

IV. Provider business mailing address

108 ROBIN RD STE 2006
ALTAMONTE SPRINGS FL
32701-5035
US

V. Phone/Fax

Practice location:
  • Phone: 407-831-2880
  • Fax: 407-831-2881
Mailing address:
  • Phone: 407-831-2880
  • Fax: 407-831-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH6241
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6877
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPY6877
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6877
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY6877
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPY6877
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY6877
License Number StateFL

VIII. Authorized Official

Name: DR. SEAN PATRICK JENNINGS
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 407-831-2880