Provider Demographics
NPI:1033203864
Name:JENNAY, LISA A (LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:JENNAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2477 STICKNEY POINT RD
Mailing Address - Street 2:SUITE 115-B
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-4076
Mailing Address - Country:US
Mailing Address - Phone:941-780-1569
Mailing Address - Fax:941-927-0236
Practice Address - Street 1:2477 STICKNEY POINT RD
Practice Address - Street 2:SUITE 115-B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4076
Practice Address - Country:US
Practice Address - Phone:941-780-1569
Practice Address - Fax:941-927-0236
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1576106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3547007OtherAETNA PN
FLZ7820OtherBLUE CROSS BLUE SHIELD PN