Healthcare Provider Details

I. General information

NPI: 1548346422
Provider Name (Legal Business Name): JOHNATHAN PAUL LEIN M.S.W., L.M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PENNSYLVANIA ST
ORLANDO FL
32806-2938
US

IV. Provider business mailing address

577 E ORANGE ST
ALTAMONTE SPRINGS FL
32701-2606
US

V. Phone/Fax

Practice location:
  • Phone: 407-936-2785
  • Fax: 407-936-2792
Mailing address:
  • Phone: 231-357-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801088216
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801088216
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: