Provider Demographics
NPI:1629719547
Name:GOLLINGER, JENNIFER (CSWI)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:GOLLINGER
Suffix:
Gender:F
Credentials:CSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5839 SW 74TH TER APT 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5238
Mailing Address - Country:US
Mailing Address - Phone:305-934-5044
Mailing Address - Fax:
Practice Address - Street 1:5839 SW 74TH TER APT 101
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5238
Practice Address - Country:US
Practice Address - Phone:305-934-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87-4663097OtherNON MEDICARE