Provider Demographics
NPI:1487838769
Name:JACKOWITZ, ENID (MA, LMHC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:ENID
Middle Name:
Last Name:JACKOWITZ
Suffix:
Gender:F
Credentials:MA, LMHC, NCC
Other - Prefix:MRS
Other - First Name:ENID
Other - Middle Name:DUCHIN
Other - Last Name:JACKOWITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMHC, NCC
Mailing Address - Street 1:661 SEMINOLA BLVD
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3057
Mailing Address - Country:US
Mailing Address - Phone:407-678-6655
Mailing Address - Fax:407-629-2068
Practice Address - Street 1:661 SEMINOLA BLVD
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-3057
Practice Address - Country:US
Practice Address - Phone:407-678-6655
Practice Address - Fax:407-629-2068
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-23
Last Update Date:2007-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health