MEDICARE: JENNIFER ANN PUPARD LICENSED PSYCHOLOGIS

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	101YS0200X	School Counselor	SS1215	FL
2	103T00000X	Psychologist	PY 9467	FL

General Provider Information

NPI Number	:	1629469200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANN PUPARD LICENSED PSYCHOLOGIS

Provider Business Mailing Address
First Line	:	3279 CLINT MOORE RD APT 206
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-3932
Country	:	US
Telephone Number	:	989-501-1796
Fax Number	:

Provider Business Practice Location Address
First Line	:	3279 CLINT MOORE RD APT 206
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-3932
Country	:	US
Telephone Number	:	989-501-1796
Fax Number	:

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

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	11/22/2017

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