Provider Demographics
NPI:1114026903
Name:SADOVNIK, JESSY (LMHC, PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSY
Middle Name:
Last Name:SADOVNIK
Suffix:
Gender:F
Credentials:LMHC, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 NE 195TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3421
Mailing Address - Country:US
Mailing Address - Phone:305-632-0630
Mailing Address - Fax:305-646-0113
Practice Address - Street 1:701 SW 27TH AVE
Practice Address - Street 2:SUITE 604
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3031
Practice Address - Country:US
Practice Address - Phone:305-646-0112
Practice Address - Fax:305-646-0113
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6670103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0561Medicare ID - Type UnspecifiedPSYCHOLOGIST