Basic Information
Provider Information
NPI: 1003291030
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOVELL
FirstName: JENNIFER
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: MA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1009 MAITLAND CENTER COMMONS BLVD
Address2: 212
City: MAITLAND
State: FL
PostalCode: 327517270
CountryCode: US
TelephoneNumber: 3217493333
FaxNumber:  
Practice Location
Address1: 2479 ALOMA AVE
Address2:  
City: WINTER PARK
State: FL
PostalCode: 327922541
CountryCode: US
TelephoneNumber: 4076576692
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/20/2015
LastUpdateDate: 01/31/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/31/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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