Healthcare Provider Details

I. General information

NPI: 1538712476
Provider Name (Legal Business Name): JEANNETTE G ALCANTARA MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E BLOOMINGDALE AVE
BRANDON FL
33511-8155
US

IV. Provider business mailing address

10723 BANFIELD DR
RIVERVIEW FL
33579-7781
US

V. Phone/Fax

Practice location:
  • Phone: 813-641-4410
  • Fax: 813-537-8580
Mailing address:
  • Phone: 813-641-4410
  • Fax: 813-537-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: