Provider Demographics
NPI:1104366152
Name:LAMONS, JACKIE DEON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JACKIE
Middle Name:DEON
Last Name:LAMONS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18441 NW 2ND AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4571
Mailing Address - Country:US
Mailing Address - Phone:786-267-5462
Mailing Address - Fax:
Practice Address - Street 1:205 NW 8TH AVE
Practice Address - Street 2:APT 202
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3906
Practice Address - Country:US
Practice Address - Phone:786-387-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL122901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical