Provider Demographics
NPI:1659774990
Name:WARNER GARMAN, JACQUELINE MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MICHELLE
Last Name:WARNER GARMAN
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 1:11336 JIM CT
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5965
Mailing Address - Country:US
Mailing Address - Phone:813-335-7431
Mailing Address - Fax:
Practice Address - Street 1:105 S ALBANY AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1710
Practice Address - Country:US
Practice Address - Phone:813-922-8237
Practice Address - Fax:813-254-3092
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW107451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical