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NPI Code Detail

MEDICARE: JESSYCA DAMERON HAYWARD LCSW

MEDICARE: JESSYCA DAMERON HAYWARD 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
11041C0700XClinical Social WorkerCSW007582GA
21041C0700XClinical Social WorkerSW18875FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366915894
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSYCA DAMERON HAYWARD LCSW
Provider Business Mailing Address
First Line : 12134 BLACKFOOT CT
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32223-3235
Country : US
Telephone Number : 904-885-3839
Fax Number :
Provider Business Practice Location Address
First Line : 3890 DUNN AVE STE 1104
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32218-6432
Country : US
Telephone Number : 904-765-0664
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2019
Last Update Date : 09/09/2021

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