MEDICARE: JUSTIN FORREST DEMENT 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	SW14624	FL

General Provider Information

NPI Number	:	1285149823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN FORREST DEMENT LCSW

Provider Business Mailing Address
First Line	:	1301 PLANTATION ISLAND DR S STE 202A
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-3111
Country	:	US
Telephone Number	:	662-315-8357
Fax Number	:	904-373-7202

Provider Business Practice Location Address
First Line	:	4925 ATLANTIC VW
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-7139
Country	:	US
Telephone Number	:	662-315-8357
Fax Number	:

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

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	06/08/2026

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