Healthcare Provider Details

I. General information

NPI: 1902583743
Provider Name (Legal Business Name): CHARO DENISE JEAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 BLACK HAWK ST
CLERMONT FL
34714-8074
US

IV. Provider business mailing address

2144 BLACK HAWK ST
CLERMONT FL
34714-8074
US

V. Phone/Fax

Practice location:
  • Phone: 407-879-8177
  • Fax:
Mailing address:
  • Phone: 407-879-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: