Healthcare Provider Details

I. General information

NPI: 1285983981
Provider Name (Legal Business Name): MILDRED REESE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MILLIE SHEPPARD LCSW

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 NW 20TH LN
GAINESVILLE FL
32605-3922
US

IV. Provider business mailing address

2066 NW 20TH LN
GAINESVILLE FL
32605-3922
US

V. Phone/Fax

Practice location:
  • Phone: 617-834-7996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW18405
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: