Provider Demographics
NPI:1962649731
Name:SMYTH, JENNIFER LEE (LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:SMYTH
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 1:1221 DAKOTA DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8406
Mailing Address - Country:US
Mailing Address - Phone:772-485-9879
Mailing Address - Fax:561-622-8035
Practice Address - Street 1:1221 DAKOTA DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8406
Practice Address - Country:US
Practice Address - Phone:772-485-9879
Practice Address - Fax:561-622-8035
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health