Provider Demographics
NPI:1265649800
Name:KIEL, JAYNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:KIEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAYNE
Other - Middle Name:
Other - Last Name:GIALLOMBARDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWR, CASAC, CEAP
Mailing Address - Street 1:6600 ILEX CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-6809
Mailing Address - Country:US
Mailing Address - Phone:239-734-0970
Mailing Address - Fax:
Practice Address - Street 1:11120 S CROWN WAY STE 1
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8718
Practice Address - Country:US
Practice Address - Phone:561-790-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033336-11041C0700X
FLSW100551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005114192OtherBCBS PROVIDER ID #
NY00020365101OtherUNIVERA PROVIDER ID #
NY005114194OtherBCBS PROVIDER ID #
NY6207408OtherIHA PROVIDER ID #