Provider Demographics
NPI:1174156301
Name:FRUGGIERO, JESSICA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:FRUGGIERO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:FRUGGIERO,
Other - Last Name:MS,
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:2250 PEMBROKE FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2586
Mailing Address - Country:US
Mailing Address - Phone:954-830-1850
Mailing Address - Fax:
Practice Address - Street 1:2250 PEMBROKE FALLS BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2586
Practice Address - Country:US
Practice Address - Phone:954-519-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL83-3511808OtherCOMMERICAL