Healthcare Provider Details

I. General information

NPI: 1285167742
Provider Name (Legal Business Name): LAURA ARMIDE JEANIS MSW, LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13173 SW 44TH ST
MIRAMAR FL
33027-3114
US

IV. Provider business mailing address

13173 SW 44TH ST
MIRAMAR FL
33027-3114
US

V. Phone/Fax

Practice location:
  • Phone: 305-929-3349
  • Fax:
Mailing address:
  • Phone: 754-280-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC24279
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200003833
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW20897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: