Provider Demographics
NPI:1083153662
Name:CLARK, SHEENA TOOLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:TOOLEY
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 DUNDEE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4103
Mailing Address - Country:US
Mailing Address - Phone:407-622-2647
Mailing Address - Fax:407-644-3058
Practice Address - Street 1:1933 DUNDEE DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4103
Practice Address - Country:US
Practice Address - Phone:407-622-2647
Practice Address - Fax:407-644-3058
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW128711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical