Provider Demographics
NPI:1619228228
Name:JESSICA ANNE DEEB, LCSW, LLC
Entity Type:Organization
Organization Name:JESSICA ANNE DEEB, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DEEB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-808-4818
Mailing Address - Street 1:9400 RIVER CROSSING BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-6033
Mailing Address - Country:US
Mailing Address - Phone:727-808-4818
Mailing Address - Fax:
Practice Address - Street 1:1006 W PLATT ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2116
Practice Address - Country:US
Practice Address - Phone:727-808-4818
Practice Address - Fax:727-375-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 85911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty