Provider Demographics
NPI:1487011839
Name:JEROME, CHRISTINA CLAIRE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:CLAIRE
Last Name:JEROME
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 1:357 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-5091
Mailing Address - Country:US
Mailing Address - Phone:407-986-1122
Mailing Address - Fax:
Practice Address - Street 1:2101 PARK CENTER DR STE 270
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7608
Practice Address - Country:US
Practice Address - Phone:407-523-1212
Practice Address - Fax:407-523-2398
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW121771041C0700X
CALCSW1084401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical