Provider Demographics
NPI:1770198129
Name:SMITH, JEANINE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7433 SE MARSH FERN LN
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-7844
Mailing Address - Country:US
Mailing Address - Phone:561-301-2934
Mailing Address - Fax:
Practice Address - Street 1:7433 SE MARSH FERN LN
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-7844
Practice Address - Country:US
Practice Address - Phone:561-301-2934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional