Provider Demographics
NPI:1003532813
Name:WEBSTER, JENNIFER (LICENSE MENTAL HEALT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:LICENSE MENTAL HEALT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N. COMMERCE PARKWAY STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326
Mailing Address - Country:US
Mailing Address - Phone:954-529-2000
Mailing Address - Fax:954-529-2001
Practice Address - Street 1:2200 N. COMMERCE PARKWAY STE 200
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326
Practice Address - Country:US
Practice Address - Phone:954-529-2000
Practice Address - Fax:954-529-2001
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health