Provider Demographics
NPI:1437938636
Name:FAANA, JOOKYOUNG JACKIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JOOKYOUNG
Middle Name:JACKIE
Last Name:FAANA
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 1:392 CANYON STONE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3936
Mailing Address - Country:US
Mailing Address - Phone:808-779-7706
Mailing Address - Fax:
Practice Address - Street 1:392 CANYON STONE CIR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3936
Practice Address - Country:US
Practice Address - Phone:808-779-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW220991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical