Healthcare Provider Details

I. General information

NPI: 1629123799
Provider Name (Legal Business Name): JENNIFER RESETAR VOLZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date: 08/30/2011
Reactivation Date: 12/09/2021

III. Provider practice location address

7481 SW 125TH AVE
MIAMI FL
33183-3505
US

IV. Provider business mailing address

7481 SW 125TH AVE
MIAMI FL
33183-3505
US

V. Phone/Fax

Practice location:
  • Phone: 302-562-9595
  • Fax:
Mailing address:
  • Phone: 302-562-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1080
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1342
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: