Basic Information
| Provider Information | |||||||||
| NPI: | 1891947321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENGELSTEIN | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | WYNNE | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7301 W. PALMETTO PARK RD. | ||||||||
| Address2: | SUITE 210B | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819328114 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7301 W. PALMETTO PARK ROAD | ||||||||
| Address2: | SUITE 210B | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819328114 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2008 | ||||||||
| LastUpdateDate: | 01/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | MH16580 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.