Provider Demographics
NPI:1912010299
Name:C.E. OF JUPITER, INC.
Entity Type:Organization
Organization Name:C.E. OF JUPITER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT, CAP
Authorized Official - Phone:772-219-9566
Mailing Address - Street 1:8005 SE DOUBLE TREE DR
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-8127
Mailing Address - Country:US
Mailing Address - Phone:772-219-8001
Mailing Address - Fax:772-219-8001
Practice Address - Street 1:819 SE FEDERAL HWY
Practice Address - Street 2:SUITE 200-B
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2952
Practice Address - Country:US
Practice Address - Phone:772-219-9566
Practice Address - Fax:772-219-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 1694106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty