Provider Demographics
NPI:1003426198
Name:O'FLAHERTY, JEANETTE (LMHC, NCC, CBHCMS)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:
Last Name:O'FLAHERTY
Suffix:
Gender:F
Credentials:LMHC, NCC, CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4395 PUU LANI PL
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-8722
Mailing Address - Country:US
Mailing Address - Phone:786-302-3500
Mailing Address - Fax:786-302-3500
Practice Address - Street 1:3800 W BROWARD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1018
Practice Address - Country:US
Practice Address - Phone:954-587-1008
Practice Address - Fax:954-208-5673
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FLMH24118101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty