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General NPI Number Information
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NPI Number | 1235645748
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Entity Type | Individual
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Provider Name | KRISTEN LEE JANICA LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 3601 SOLANA CIRCLE UNIT D
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City | CLERMONT
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State | FL
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Zip | 34711
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Country | US
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Telephone | 352-234-6134
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Fax | 407-583-6487
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Provider Business Mailing Address
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Address Line | 7 LIVE OAK AVE
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City | YALAHA
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State | FL
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Zip | 34797
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Country | US
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Telephone | 352-234-6134
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Fax | 321-256-0307
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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 | SW17769
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License Number State | FL
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