Provider Demographics
NPI:1023358702
Name:CARDOZA, JESSICA JEAN (MS)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:JEAN
Last Name:CARDOZA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 W STATE ROAD 434 STE 102
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5019
Mailing Address - Country:US
Mailing Address - Phone:407-325-4726
Mailing Address - Fax:407-612-2359
Practice Address - Street 1:2139 W STATE ROAD 434 STE 102
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-5019
Practice Address - Country:US
Practice Address - Phone:407-325-4726
Practice Address - Fax:407-612-2359
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116426900Medicaid
FL019191200Medicaid