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General NPI Number Information
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NPI Number | 1104366152
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Entity Type | Individual
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Provider Name | JACKIE DEON LAMONS LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/23/2017
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 205 NW 8TH AVE APT 202
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-3906
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Country | US
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Telephone | 786-387-4777
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Fax |
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Provider Business Mailing Address
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Address Line | 18441 NW 2ND AVE STE 116
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City | MIAMI
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State | FL
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Zip | 33169-4571
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Country | US
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Telephone | 786-267-5462
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12290
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License Number State | FL
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