Healthcare Provider Details

I. General information

NPI: 1164337382
Provider Name (Legal Business Name): FERN PSYCHOTHERAPY & CLINICAL TRAINING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 SUN CITY CENTER PLZ STE 204B
SUN CITY CENTER FL
33573-5334
US

IV. Provider business mailing address

16162 COQUINA BAY LN
WIMAUMA FL
33598-4060
US

V. Phone/Fax

Practice location:
  • Phone: 813-419-4096
  • Fax: 813-419-4096
Mailing address:
  • Phone: 813-419-4096
  • Fax: 813-419-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. FRANCINE S. FERN
Title or Position: OWNER
Credential: LCSW, QS
Phone: 813-419-4096