Provider Demographics
NPI:1376969253
Name:JUSTINE HEALAN INC
Entity Type:Organization
Organization Name:JUSTINE HEALAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEALAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-910-3290
Mailing Address - Street 1:1412 PARK SHORE CIR APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9626
Mailing Address - Country:US
Mailing Address - Phone:239-910-3290
Mailing Address - Fax:
Practice Address - Street 1:1412 PARK SHORE CIR APT 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9626
Practice Address - Country:US
Practice Address - Phone:239-910-3290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW61721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty