Provider Demographics
NPI:1689014953
Name:CAMPOS, JENNIFER ANEL (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANEL
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:ANEL
Other - Last Name:MORTAZAVI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:701 SW 27TH AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3031
Mailing Address - Country:US
Mailing Address - Phone:305-668-9000
Mailing Address - Fax:
Practice Address - Street 1:701 SW 27TH AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3031
Practice Address - Country:US
Practice Address - Phone:305-668-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2789106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist