Provider Demographics
NPI:1518272194
Name:TROTTER, JENNIFER (MA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:TROTTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WHITECAPS CIR
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5852
Mailing Address - Country:US
Mailing Address - Phone:407-353-1484
Mailing Address - Fax:
Practice Address - Street 1:100 E SYBELIA AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4763
Practice Address - Country:US
Practice Address - Phone:407-353-1484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10052101YM0800X
FLMT2444106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12093435OtherCAQH