Provider Demographics
NPI:1679503742
Name:VANDENOEVER, WILEEN LORETTA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:WILEEN
Middle Name:LORETTA
Last Name:VANDENOEVER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:WILEEN
Other - Middle Name:LORETTA
Other - Last Name:JUDKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5453 HARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-7204
Mailing Address - Country:US
Mailing Address - Phone:904-755-1914
Mailing Address - Fax:
Practice Address - Street 1:5453 HARDEN RD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-7204
Practice Address - Country:US
Practice Address - Phone:904-755-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW81651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical