=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447680277
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR INTEGRATIVE PSYCHOLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2013
-----------------------------------------------------
Last Update Date | 11/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 374 HERONS RUN DR. 907
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34232-1771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-953-9130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 374 HERONS RUN DR. 907
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34232-1771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-953-9130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MARRIAGE AND FAMILY THERAPIST
-----------------------------------------------------
Name | DR. MARILYN JENAI
-----------------------------------------------------
Credential | 9419539130
-----------------------------------------------------
Telephone | 941-953-9130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 524
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------