MEDICARE: JANEAN FURDOCK 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	SW7776	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	:	1548315138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANEAN FURDOCK LCSW

Provider Business Mailing Address
First Line	:	35114 STAGECOACH TRL
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32736-8004
Country	:	US
Telephone Number	:	321-377-2243
Fax Number	:	352-589-6738

Provider Business Practice Location Address
First Line	:	35114 STAGECOACH TRL
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32736-8004
Country	:	US
Telephone Number	:	321-377-2243
Fax Number	:	352-589-6738

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	12/01/2016

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