MEDICARE: DELSONDRA JONELL ALLEN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW16376	FL
2	1041C0700X	Clinical Social Worker	C018104	NC
3	1041C0700X	Clinical Social Worker	CSW009579	GA
4	1041C0700X	Clinical Social Worker	14834	SC

General Provider Information

NPI Number	:	1083274708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELSONDRA JONELL ALLEN LCSW

Provider Business Mailing Address
First Line	:	7101 WILSON BLVD APT 2204
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3690
Country	:	US
Telephone Number	:	843-476-0175
Fax Number	:

Provider Business Practice Location Address
First Line	:	7643 GATE PKWY STE 104-1712
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-3092
Country	:	US
Telephone Number	:	843-476-0175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	12/20/2025

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