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General NPI Number Information
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NPI Number | 1114329117
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Entity Type | Organization
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Legal Business Name | JHMINOGUE, LCSW, INC.
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 320 S B ST
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City | LAKE WORTH
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State | FL
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Zip | 33460-4039
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Country | US
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Telephone | 504-813-0519
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Fax |
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Provider Business Mailing Address
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Address Line | 521 LAKE AVE STE 9
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City | LAKE WORTH
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State | FL
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Zip | 33460-3846
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Country | US
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Telephone | 561-203-5402
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER MINOGUE
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Credential | LCSW
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Telephone | 561-203-5402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW11685
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License Number State | FL
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