MEDICARE: JOELLEN REVELL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW11571	FL

General Provider Information

NPI Number	:	1154182426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOELLEN REVELL LCSW

Provider Business Mailing Address
First Line	:	PO BOX 491000
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34749-1000
Country	:	US
Telephone Number	:	352-315-7500
Fax Number	:	352-314-8858

Provider Business Practice Location Address
First Line	:	515 W MAIN ST
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-5148
Country	:	US
Telephone Number	:	352-315-7500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	01/23/2024

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Directions to “ JOELLEN REVELL LCSW” Practice Location

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