Healthcare Provider Details

I. General information

NPI: 1730658345
Provider Name (Legal Business Name): JARED WILLIAM CHANTRILL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 09/11/2025
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 LOUISIANA AVE STE A
SAINT CLOUD FL
34769-4116
US

IV. Provider business mailing address

5655 S ORANGE AVE
EDGEWOOD FL
32809-4289
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-0122
  • Fax: 407-593-0081
Mailing address:
  • Phone: 866-280-9355
  • Fax: 833-565-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-4280
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: