Provider Demographics
NPI:1477894343
Name:HOPPER, KRISTEN JILLENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:JILLENE
Last Name:HOPPER
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:PO BOX 491000
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-1000
Mailing Address - Country:US
Mailing Address - Phone:523-748-5475
Mailing Address - Fax:
Practice Address - Street 1:901 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785
Practice Address - Country:US
Practice Address - Phone:352-748-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-02
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0649891041C0700X
FLSW138991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical