Provider Demographics
NPI:1053735241
Name:CHAVARRO CASTILLO, JENNIFER (LMHC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:CHAVARRO CASTILLO
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 1:510 VONDERBURG DR.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6072
Mailing Address - Country:US
Mailing Address - Phone:813-881-1000
Mailing Address - Fax:813-881-0003
Practice Address - Street 1:510 VONDERBURG DR
Practice Address - Street 2:SUITE 301
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5954
Practice Address - Country:US
Practice Address - Phone:813-881-1000
Practice Address - Fax:813-881-0003
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 12557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
13798116OtherCAQH