Provider Demographics
NPI:1578281226
Name:MANELLI, JENNA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:MANELLI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 W OBISPO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6737
Mailing Address - Country:US
Mailing Address - Phone:813-503-6581
Mailing Address - Fax:
Practice Address - Street 1:2325 ULMERTON RD STE 7G
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3362
Practice Address - Country:US
Practice Address - Phone:727-231-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11485103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical