=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679926307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRAL PATH ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2016
-----------------------------------------------------
Last Update Date | 08/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2831 RINGLING BLVD STE C110B
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34237-5334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-735-7640
-----------------------------------------------------
Fax | 941-200-4137
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8388 S TAMIAMI TRL STE 187
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34238-2934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-735-7640
-----------------------------------------------------
Fax | 941-200-4137
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JUANITA CHENAULT
-----------------------------------------------------
Credential | MSW, LCSW
-----------------------------------------------------
Telephone | 941-735-7640
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW13526
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------