Healthcare Provider Details

I. General information

NPI: 1699493213
Provider Name (Legal Business Name): JESSICA LYNN DVORSCAK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

1501 SW 37TH AVE APT 1006
MIAMI FL
33145-1154
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax:
Mailing address:
  • Phone: 219-779-2199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22855
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: