Healthcare Provider Details

I. General information

NPI: 1497276711
Provider Name (Legal Business Name): JOANNE JEAN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7437 LAURA ST N
JACKSONVILLE FL
32208-4117
US

IV. Provider business mailing address

7437 LAURA ST N
JACKSONVILLE FL
32208-4117
US

V. Phone/Fax

Practice location:
  • Phone: 352-234-6717
  • Fax: 866-441-1108
Mailing address:
  • Phone: 362-234-6717
  • Fax: 866-441-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW17576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: