Provider Demographics
NPI:1457325912
Name:WHITAKER-ORR, JOY MIRIAM (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:MIRIAM
Last Name:WHITAKER-ORR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JOY
Other - Middle Name:W
Other - Last Name:ORR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:15215 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6072
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-799-2215
Practice Address - Street 1:14690 SPRING HILL DR
Practice Address - Street 2:STE #201
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-8102
Practice Address - Country:US
Practice Address - Phone:352-397-4481
Practice Address - Fax:352-799-2215
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038912-01101YM0800X
FLPSW7901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDD598ZOtherMEDICARE
NY01829574Medicaid
NY01829574Medicaid