Provider Demographics
NPI:1700104544
Name:MAGBANUA, D. JENNIFER (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:D.
Middle Name:JENNIFER
Last Name:MAGBANUA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:D.
Other - Middle Name:JENNIFER
Other - Last Name:MAINWARING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7651 ASHLEY PARK CT # B
Mailing Address - Street 2:SUITE 404
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6114
Mailing Address - Country:US
Mailing Address - Phone:407-536-8877
Mailing Address - Fax:
Practice Address - Street 1:7651 ASHLEY PARK CT # B
Practice Address - Street 2:SUITE 404
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6114
Practice Address - Country:US
Practice Address - Phone:407-536-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2439106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist