Healthcare Provider Details

I. General information

NPI: 1104626258
Provider Name (Legal Business Name): JENDAYI CAINES BS, MBA, MA, RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9611 TOCOBAGA PL
RIVERVIEW FL
33578-4922
US

IV. Provider business mailing address

9611 TOCOBAGA PL
RIVERVIEW FL
33578-4922
US

V. Phone/Fax

Practice location:
  • Phone: 860-986-0842
  • Fax:
Mailing address:
  • Phone: 860-986-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH27020
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: