Provider Demographics
NPI:1568933844
Name:REESE, CARRIE BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:BETH
Last Name:REESE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:BETH
Other - Last Name:VEDDERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1016 W AIKEN ST
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-9515
Mailing Address - Country:US
Mailing Address - Phone:904-540-3604
Mailing Address - Fax:904-547-2215
Practice Address - Street 1:1016 W AIKEN ST
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-9515
Practice Address - Country:US
Practice Address - Phone:904-540-3604
Practice Address - Fax:904-547-2215
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW157141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical