MEDICARE: MS. JENNIFER GOLLINGER CSWI

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	101YM0800X	Mental Health Counselor		FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87-4663097	OTHER	FL	NON MEDICARE

General Provider Information

NPI Number	:	1629719547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER GOLLINGER CSWI

Provider Business Mailing Address
First Line	:	5839 SW 74TH TER APT 101
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5238
Country	:	US
Telephone Number	:	305-934-5044
Fax Number	:

Provider Business Practice Location Address
First Line	:	5839 SW 74TH TER APT 101
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5238
Country	:	US
Telephone Number	:	305-934-5044
Fax Number	:

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

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	04/05/2022

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