MEDICARE: MS. JENNIFER NIKOLE KENDRA MARVIN LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	MH5186	FL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	MH5186	FL
3	101YP2500X	Professional Counselor	MH5186	FL
4	104100000X	Social Worker	MH5186	FL
5	101YM0800X	Mental Health Counselor	MH5186	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215150420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER NIKOLE KENDRA MARVIN LMHC

Provider Business Mailing Address
First Line	:	4726 FLORENCE ST
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-5540
Country	:	US
Telephone Number	:	407-929-6251
Fax Number	:	407-788-0362

Provider Business Practice Location Address
First Line	:	2400 S RIDGEWOOD AVE STE 17
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-3073
Country	:	US
Telephone Number	:	407-929-6251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	10/08/2019

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