Healthcare Provider Details

I. General information

NPI: 1003846114
Provider Name (Legal Business Name): ELIZABETH DOWELL PASCOE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 STOWE AVE
ORANGE PARK FL
32073-5652
US

IV. Provider business mailing address

133 STOWE AVE
ORANGE PARK FL
32073-5652
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-0886
  • Fax: 904-269-0499
Mailing address:
  • Phone: 904-269-0886
  • Fax: 904-269-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW8104
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: