Provider Demographics
NPI:1447773270
Name:REASONOVER, LORI T (LCSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:T
Last Name:REASONOVER
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 1:4079 GLENHURST DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2297
Mailing Address - Country:US
Mailing Address - Phone:904-220-6883
Mailing Address - Fax:
Practice Address - Street 1:305 KINGSLEY LAKE DR STE 702
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3045
Practice Address - Country:US
Practice Address - Phone:904-993-0019
Practice Address - Fax:904-993-0019
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW146401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical