Provider Demographics
NPI:1538115977
Name:FLEISHMAN, JONATHAN ELI (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ELI
Last Name:FLEISHMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 OGLETHORPE PROFESSIONAL BLVD
Mailing Address - Street 2:UNIT 3
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3608
Mailing Address - Country:US
Mailing Address - Phone:912-856-9453
Mailing Address - Fax:912-352-4220
Practice Address - Street 1:7 OGLETHORPE PROFESSIONAL BLVD
Practice Address - Street 2:UNIT 3
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3608
Practice Address - Country:US
Practice Address - Phone:912-856-9453
Practice Address - Fax:912-352-4220
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA26831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFLSW25092Medicare ID - Type UnspecifiedLISW
OHS95512Medicare UPIN
OHFLSW25093Medicare ID - Type UnspecifiedLISW
GA202I803778Medicare PIN