Provider Demographics
NPI:1619250958
Name:DRAKE, JILL RAND (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:RAND
Last Name:DRAKE
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 1:1505 ORCHID AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5649
Mailing Address - Country:US
Mailing Address - Phone:407-644-4692
Mailing Address - Fax:407-644-4882
Practice Address - Street 1:1505 ORCHID AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5649
Practice Address - Country:US
Practice Address - Phone:407-644-4692
Practice Address - Fax:407-644-4882
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW74671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical