Healthcare Provider Details

I. General information

NPI: 1225026644
Provider Name (Legal Business Name): JACQUELINE CAGNEY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 01/28/2024
Certification Date: 01/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5571 N UNIVERSITY DR #101
CORAL SPRINGS FL
33067
US

IV. Provider business mailing address

5571 N UNIVERSITY DR #101
CORAL SPRINGS FL
33067
US

V. Phone/Fax

Practice location:
  • Phone: 954-544-4991
  • Fax: 954-544-4992
Mailing address:
  • Phone: 954-544-4991
  • Fax: 954-544-4992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT0001579
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1589
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMT1579
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT1579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: