Provider Demographics
NPI:1891847778
Name:CORAGGIO, JENNIFER (LMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CORAGGIO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 N BELCHER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1454
Mailing Address - Country:US
Mailing Address - Phone:727-386-8900
Mailing Address - Fax:727-797-8690
Practice Address - Street 1:1802 N BELCHER RD STE 102
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1454
Practice Address - Country:US
Practice Address - Phone:727-386-8900
Practice Address - Fax:727-797-8690
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5843101YM0800X
FLMH 5843101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL761003300Medicaid