MEDICARE: MRS. JAIME CROSSAN-DEBRES 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	SW12818	FL

General Provider Information

NPI Number	:	1437524279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAIME CROSSAN-DEBRES LCSW

Provider Business Mailing Address
First Line	:	851 5TH AVE N
Second Line	:	SUITE 201
City	:	NAPLES
State	:	FL
Zip	:	34102-5582
Country	:	US
Telephone Number	:	239-659-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	851 5TH AVE N
Second Line	:	SUITE 201
City	:	NAPLES
State	:	FL
Zip	:	34102-5582
Country	:	US
Telephone Number	:	239-659-7733
Fax Number	:

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

Provider Enumeration Date	:	12/04/2015
Last Update Date	:	09/13/2016

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