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General NPI Number Information
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NPI Number | 1184178311
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Entity Type | Individual
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Provider Name | JESSICA RUTH GREAVES LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 2810 W SAINT ISABEL ST STE 201B
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City | TAMPA
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State | FL
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Zip | 33607-6375
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Country | US
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Telephone | 813-236-4673
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Fax | 813-236-4689
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Provider Business Mailing Address
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Address Line | 115 W OSBORNE AVE
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City | TAMPA
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State | FL
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Zip | 33603-2017
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Country | US
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Telephone | 813-505-6867
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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 | ISW 9373
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW14306
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License Number State | FL
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