Healthcare Provider Details

I. General information

NPI: 1578034419
Provider Name (Legal Business Name): JENNIFER N YODER P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 W PALMETTO PARK RD STE 15-149
BOCA RATON FL
33433-3426
US

IV. Provider business mailing address

7050 W PALMETTO PARK RD STE 15-149
BOCA RATON FL
33433-3426
US

V. Phone/Fax

Practice location:
  • Phone: 954-417-3820
  • Fax:
Mailing address:
  • Phone: 954-417-3820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER YODER
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 954-417-3820