Healthcare Provider Details

I. General information

NPI: 1922369032
Provider Name (Legal Business Name): JEANINE CECEIL WOODEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18105 SW 88TH CT
PALMETTO BAY FL
33157-5976
US

IV. Provider business mailing address

18105 SW 88TH CT
PALMETTO BAY FL
33157-5976
US

V. Phone/Fax

Practice location:
  • Phone: 305-254-9759
  • Fax:
Mailing address:
  • Phone: 305-742-8291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: