Provider Demographics
NPI:1922787050
Name:BAKER, JENNIFER RAGUSA (RMHCI, RMFTI, NCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAGUSA
Last Name:BAKER
Suffix:
Gender:F
Credentials:RMHCI, RMFTI, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 LOUISIANA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2350
Mailing Address - Country:US
Mailing Address - Phone:407-205-2915
Mailing Address - Fax:
Practice Address - Street 1:1133 LOUISIANA AVE STE 106
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2350
Practice Address - Country:US
Practice Address - Phone:407-205-2915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health