Provider Demographics
NPI:1588285373
Name:SANCHEZ, JENNIFER (PHD CRC CVE LP LMHC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:PHD CRC CVE LP LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 NAVARRE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4634
Mailing Address - Country:US
Mailing Address - Phone:608-622-5243
Mailing Address - Fax:
Practice Address - Street 1:4902 NAVARRE RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-4634
Practice Address - Country:US
Practice Address - Phone:608-622-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-03
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097602101YM0800X
FL1077884101YS0200X
00112743225C00000X
IA097603103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor