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General NPI Number Information
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NPI Number | 1447773270
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Entity Type | Individual
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Provider Name | LORI T REASONOVER LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 07/24/2017
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Provider Practice Location Address
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Address Line | 305 KINGSLEY LAKE DR STE 702
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3045
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Country | US
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Telephone | 904-993-0019
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Fax | 904-993-0019
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Provider Business Mailing Address
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Address Line | 4079 GLENHURST DR N
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City | JACKSONVILLE
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State | FL
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Zip | 32224-2297
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Country | US
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Telephone | 904-220-6883
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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 | SW14640
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License Number State | FL
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