Provider Demographics
NPI:1407126998
Name:DAHLEN, LLOYD ERNEST II (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:ERNEST
Last Name:DAHLEN
Suffix:II
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 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-8900
Mailing Address - Fax:
Practice Address - Street 1:7751 BAYMEADOWS RD E STE G
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5836
Practice Address - Country:US
Practice Address - Phone:904-450-8900
Practice Address - Fax:904-450-8938
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI35811041C0700X
FL138471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13847OtherLCSW
13656971OtherCAQH