Provider Demographics
NPI:1629117494
Name:KNEER, JODI LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNN
Last Name:KNEER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JODI
Other - Middle Name:LYNN
Other - Last Name:MARING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:51 S MAIN AVE
Mailing Address - Street 2:STE 304
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3937
Mailing Address - Country:US
Mailing Address - Phone:813-789-5634
Mailing Address - Fax:727-784-8244
Practice Address - Street 1:51 S MAIN AVE
Practice Address - Street 2:STE 304
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3937
Practice Address - Country:US
Practice Address - Phone:727-784-8244
Practice Address - Fax:727-287-9302
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 57781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL243084OtherAMERIGROUP
FL593639872OtherGROUP ID