MEDICARE: MRS. JENNIFER EASLEY 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	012163	NC
2	1041C0700X	Clinical Social Worker	16810	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1528462157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER EASLEY LCSW

Provider Business Mailing Address
First Line	:	4024 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33711-1239
Country	:	US
Telephone Number	:	727-327-7656
Fax Number	:

Provider Business Practice Location Address
First Line	:	7720 EAGLE CHASE DR
Second Line	:
City	:	WILLOW SPRING
State	:	NC
Zip	:	27592-8652
Country	:	US
Telephone Number	:	814-248-8983
Fax Number	:

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

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	06/08/2026

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