Provider Demographics
NPI:1114240777
Name:DEEB, JESSICA ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:DEEB
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 1:9400 RIVER CROSSING BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-6033
Mailing Address - Country:US
Mailing Address - Phone:727-808-4818
Mailing Address - Fax:727-375-8631
Practice Address - Street 1:9400 RIVER CROSSING BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-6033
Practice Address - Country:US
Practice Address - Phone:727-808-4818
Practice Address - Fax:727-375-8631
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 85911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical