Healthcare Provider Details

I. General information

NPI: 1962064980
Provider Name (Legal Business Name): ANIA E JARMULOWICZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2019
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 JACKEYS TRACE RD
LELAND NC
28451-4302
US

IV. Provider business mailing address

2825 JACKEYS TRACE RD
LELAND NC
28451-4302
US

V. Phone/Fax

Practice location:
  • Phone: 727-358-6426
  • Fax:
Mailing address:
  • Phone: 727-358-6426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW17955
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC019067
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL05952800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: