Provider Demographics
NPI:1477169209
Name:DASH, JENNIFER (MHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DASH
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 S OAKLAND FOREST DR APT 102
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5698
Mailing Address - Country:US
Mailing Address - Phone:954-529-6980
Mailing Address - Fax:
Practice Address - Street 1:4390 N FEDERAL HWY STE 208
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5200
Practice Address - Country:US
Practice Address - Phone:954-263-4517
Practice Address - Fax:954-859-2049
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17342101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health