| Entity Name: | CHARU JAIN, PSY.D. LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Sep 2014 (10 years ago) |
| Document Number: | L14000154136 |
| FEI/EIN Number | 47-2177668 |
| Address: | 300 NW 70 AVE, Plantation, FL, 33317, US |
| Mail Address: | 300 NW 70 AVE, Plantation, FL, 33317, US |
| ZIP code: | 33317 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396296810 | 2016-10-19 | 2016-10-19 | 7420 NW 5TH ST, SUITE 103, PLANTATION, FL, 333171611, US | 7420 NW 5TH ST, SUITE 103, PLANTATION, FL, 333171611, US | |||||||||||||||||||||||||
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| Phone | +1 954-817-6372 |
| Fax | 9545878686 |
Authorized person
| Name | CHARU JAIN |
| Role | PRESIDENT |
| Phone | 9548176372 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY9137 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | LICENCE NUMBER |
| Number | PY9137 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JAIN CHARU | Agent | 300 NW 70 AVE, Plantation, FL, 33317 |
| Name | Role | Address |
|---|---|---|
| JAIN CHARU | Manager | 300 NW 70 AVE, Plantation, FL, 33317 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000053899 | BROWARD PSYCHOLOGY CENTER | ACTIVE | 2021-04-19 | 2026-12-31 | No data | 7420 NW 5 ST, SUITE 103, PLANTATION, FL, 33317 |
| G14000108757 | BROWARD PSYCHOLOGY CENTER | EXPIRED | 2014-10-27 | 2019-12-31 | No data | 2743 BIRCH TERR, DAVIE, FL, 33330 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-04 | 300 NW 70 AVE, Suite 107, Plantation, FL 33317 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-11-21 | 300 NW 70 AVE, Suite 107, Plantation, FL 33317 | No data |
| CHANGE OF MAILING ADDRESS | 2022-11-21 | 300 NW 70 AVE, Suite 107, Plantation, FL 33317 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-03 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-02-25 |
| ANNUAL REPORT | 2020-03-26 |
| ANNUAL REPORT | 2019-02-26 |
| ANNUAL REPORT | 2018-03-03 |
| ANNUAL REPORT | 2017-02-22 |
| ANNUAL REPORT | 2016-04-04 |
| ANNUAL REPORT | 2015-03-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
