Provider Demographics
NPI:1134719073
Name:WARWICK, JENNIFER (MS, RMFTI)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WARWICK
Suffix:
Gender:F
Credentials:MS, RMFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 FRUITVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-8943
Mailing Address - Country:US
Mailing Address - Phone:941-720-6567
Mailing Address - Fax:
Practice Address - Street 1:1283 FRUITVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-8943
Practice Address - Country:US
Practice Address - Phone:941-720-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT2718101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE