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General NPI Number Information
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NPI Number | 1922698604
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Entity Type | Individual
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Provider Name | LETHA DAISY PAGE LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 8647 BAYPINE RD STE. 206
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7544
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Country | US
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Telephone | 904-490-6974
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Fax | 866-489-5550
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Provider Business Mailing Address
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Address Line | 12973 CHETS CREEK DR S
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City | JACKSONVILLE
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State | FL
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Zip | 32224-7485
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Country | US
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Telephone | 904-580-4535
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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 | SW18959
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License Number State | FL
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