Provider Demographics
NPI:1598472821
Name:SHABOT, JAN ROSALYN (LCSW)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:ROSALYN
Last Name:SHABOT
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 1:12204 SUSSEX ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8589
Mailing Address - Country:US
Mailing Address - Phone:561-809-9938
Mailing Address - Fax:
Practice Address - Street 1:12204 SUSSEX ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8589
Practice Address - Country:US
Practice Address - Phone:561-809-9938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW171251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical