Provider Demographics
NPI:1598207508
Name:JORGE, ANNA MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:JORGE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7464 154TH CT N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1952
Mailing Address - Country:US
Mailing Address - Phone:561-222-4626
Mailing Address - Fax:
Practice Address - Street 1:4425 MILITARY TRL STE 203
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4817
Practice Address - Country:US
Practice Address - Phone:561-747-2775
Practice Address - Fax:561-747-1881
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLSW111871041C0700X
FLSW157851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101372400Medicaid