Provider Demographics
NPI:1699005298
Name:AUSTIN-DANNER, JEAN C (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:C
Last Name:AUSTIN-DANNER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7991 CANYON LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5383
Mailing Address - Country:US
Mailing Address - Phone:407-399-6311
Mailing Address - Fax:407-730-4636
Practice Address - Street 1:1803 PARK CENTER DR
Practice Address - Street 2:SUITE 111
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6216
Practice Address - Country:US
Practice Address - Phone:407-399-6311
Practice Address - Fax:407-730-4636
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW54441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1720309115OtherNPPES---NPI NUMBER FOR LLC
FL26-1162956OtherIRS
FLDD737ZMedicare PIN
FL26-1162956OtherIRS