Provider Demographics
NPI:1821266479
Name:ESTRADA, JENNIFER MAE (LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-1833
Mailing Address - Country:US
Mailing Address - Phone:561-667-5231
Mailing Address - Fax:
Practice Address - Street 1:2393 S CONGRESS AVE STE 211
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-7628
Practice Address - Country:US
Practice Address - Phone:561-320-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9160101YM0800X
FLMH 9160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty