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General NPI Number Information
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NPI Number | 1679639124
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Entity Type | Individual
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Provider Name | JANE A PEACH LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 2194 A1A HWY SUITE 204
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-4930
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Country | US
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Telephone | 321-848-1971
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Fax | 321-773-5479
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Provider Business Mailing Address
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Address Line | 170 WHITE IBIS LN
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City | INDIALANTIC
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State | FL
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Zip | 32903-2097
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Country | US
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Telephone | 321-848-1971
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Fax | 321-773-5479
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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 | 9079
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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 | 003334
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License Number State | GA
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