Provider Demographics
NPI:1518280601
Name:MATTHEWS, JENNIFER M (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MATTHEWS
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 1:9143 PHILIPS HWY
Mailing Address - Street 2:SUITE 560
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1348
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-538-3672
Practice Address - Street 1:9143 PHILIPS HWY
Practice Address - Street 2:SUITE 560
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1348
Practice Address - Country:US
Practice Address - Phone:904-363-2113
Practice Address - Fax:904-538-3672
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW77521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical