Provider Demographics
NPI:1114329117
Name:JHMINOGUE, LCSW, INC.
Entity Type:Organization
Organization Name:JHMINOGUE, LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-203-5402
Mailing Address - Street 1:521 LAKE AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-3846
Mailing Address - Country:US
Mailing Address - Phone:561-203-5402
Mailing Address - Fax:
Practice Address - Street 1:320 S B ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-4039
Practice Address - Country:US
Practice Address - Phone:504-813-0519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW116851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty