Healthcare Provider Details

I. General information

NPI: 1366381204
Provider Name (Legal Business Name): JENNIFER LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LOPEZ CORDOVI MSW, RCSWI

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 41ST OCEAN
MARATHON FL
33050-2373
US

IV. Provider business mailing address

369 110TH STREET OCEAN
MARATHON FL
33050-3440
US

V. Phone/Fax

Practice location:
  • Phone: 305-902-7534
  • Fax:
Mailing address:
  • Phone: 561-374-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW20784
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: