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General NPI Number Information
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NPI Number | 1649714916
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Entity Type | Organization
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Legal Business Name | JANEAN FURDOCK, LCSW
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 35114 STAGECOACH TRL
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City | EUSTIS
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State | FL
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Zip | 32736-8004
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Country | US
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Telephone | 321-377-2243
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Fax | 352-589-6738
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Provider Business Mailing Address
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Address Line | 35114 STAGECOACH TRL
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City | EUSTIS
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State | FL
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Zip | 32736-8004
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Country | US
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Telephone | 321-377-2243
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Fax | 352-589-6738
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Authorized Official
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Title or Position | OWNER
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Name | JANEAN FURDOCK
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Credential | LCSW
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Telephone | 321-377-2243
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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 | SW7776
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License Number State | FL
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