Healthcare Provider Details

I. General information

NPI: 1174156301
Provider Name (Legal Business Name): JESSICA FRUGGIERO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA FRUGGIERO, MS, LMHC

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 PEMBROKE FALLS BLVD
PEMBROKE PINES FL
33028-2586
US

IV. Provider business mailing address

2250 PEMBROKE FALLS BLVD
PEMBROKE PINES FL
33028-2586
US

V. Phone/Fax

Practice location:
  • Phone: 954-519-2606
  • Fax:
Mailing address:
  • Phone: 954-830-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: