Provider Demographics
NPI:1245783463
Name:TRIMBLE, JAMEELAH S (LCSW)
Entity Type:Individual
Prefix:PROF
First Name:JAMEELAH
Middle Name:S
Last Name:TRIMBLE
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 1:1125 NE 125TH ST
Mailing Address - Street 2:SUITE 228
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5034
Mailing Address - Country:US
Mailing Address - Phone:305-981-1700
Mailing Address - Fax:844-270-3323
Practice Address - Street 1:1125 NE 125TH ST
Practice Address - Street 2:SUITE 228
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5034
Practice Address - Country:US
Practice Address - Phone:305-981-1700
Practice Address - Fax:844-270-3323
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW136101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW13610OtherLICENSED CLINICAL SOCIAL WORKER