Healthcare Provider Details

I. General information

NPI: 1366611451
Provider Name (Legal Business Name): MJEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 N COMMERCE PKWY STE 3
WESTON FL
33326-3252
US

IV. Provider business mailing address

2233 N COMMERCE PKWY STE 3
WESTON FL
33326-3252
US

V. Phone/Fax

Practice location:
  • Phone: 954-217-1757
  • Fax: 954-385-3807
Mailing address:
  • Phone: 954-217-1757
  • Fax: 954-385-3807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CLEMENTE
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 954-217-1757