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General NPI Number Information
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NPI Number | 1356038277
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Entity Type | Individual
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Provider Name | JESSICA LOEB
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Gender | Female
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Dates
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Enumeration Date | 04/20/2023
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 7376 NW 5TH ST
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City | PLANTATION
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State | FL
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Zip | 33317-1605
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Country | US
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Telephone | 754-444-1046
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Fax |
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Provider Business Mailing Address
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Address Line | 1081 SW 4TH TER
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City | POMPANO BEACH
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State | FL
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Zip | 33060-8603
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Country | US
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Telephone | 561-669-9774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MT4624
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License Number State | FL
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