Healthcare Provider Details

I. General information

NPI: 1003532813
Provider Name (Legal Business Name): JENNIFER WEBSTER LICENSE MENTAL HEALT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N. COMMERCE PARKWAY STE 200
WESTON FL
33326
US

IV. Provider business mailing address

2200 N. COMMERCE PARKWAY STE 200
WESTON FL
33326
US

V. Phone/Fax

Practice location:
  • Phone: 954-529-2000
  • Fax: 954-529-2001
Mailing address:
  • Phone: 954-529-2000
  • Fax: 954-529-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: