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General NPI Number Information
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NPI Number | 1790991214
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Entity Type | Individual
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Provider Name | JEAN A. PEASE LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 03/08/2019
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Provider Practice Location Address
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Address Line | 4375 US HIGHWAY 17 SUITE 103
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4832
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Country | US
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Telephone | 904-269-0886
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Fax | 904-269-0499
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Provider Business Mailing Address
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Address Line | 1985 ARDEN FOREST PL
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-2304
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Country | US
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Telephone | 904-333-1996
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | SW7416
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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 | SW7416
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License Number State | FL
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