Provider Demographics
NPI:1992992390
Name:BISHOP, JENNIFER NOEL (MS)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:NOEL
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15135 MICHELANGELO BLVD
Mailing Address - Street 2:#205
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-6016
Mailing Address - Country:US
Mailing Address - Phone:954-892-8603
Mailing Address - Fax:
Practice Address - Street 1:6971 N FEDERAL HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1656
Practice Address - Country:US
Practice Address - Phone:561-408-1098
Practice Address - Fax:561-408-1099
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9247101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health