Provider Demographics
NPI:1689228355
Name:OLIVER, JESSICA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:OLIVER
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 1:36178 GRESHAM RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:FL
Mailing Address - Zip Code:33597-9287
Mailing Address - Country:US
Mailing Address - Phone:813-449-2500
Mailing Address - Fax:
Practice Address - Street 1:36178 GRESHAM RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:FL
Practice Address - Zip Code:33597-9287
Practice Address - Country:US
Practice Address - Phone:813-449-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
FLISW133581041C0700X
FLSW181011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator