Healthcare Provider Details

I. General information

NPI: 1487294484
Provider Name (Legal Business Name): JENNIFER MARSHA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N RONALD REAGAN BLVD STE 218
LONGWOOD FL
32750-5902
US

IV. Provider business mailing address

300 N RONALD REAGAN BLVD STE 218
LONGWOOD FL
32750-5902
US

V. Phone/Fax

Practice location:
  • Phone: 407-801-9185
  • Fax:
Mailing address:
  • Phone: 407-801-9185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER GENEUS
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential:
Phone: 407-801-9185