Provider Demographics
NPI:1710943717
Name:MASCIALE-SHOEMAKER, JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:MASCIALE-SHOEMAKER
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 1:1275 S PATRICK DR
Mailing Address - Street 2:STE C
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3963
Mailing Address - Country:US
Mailing Address - Phone:321-779-9838
Mailing Address - Fax:321-779-4502
Practice Address - Street 1:1275 S PATRICK DR
Practice Address - Street 2:STE C
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3963
Practice Address - Country:US
Practice Address - Phone:321-779-9838
Practice Address - Fax:321-779-4502
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW36521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6309Medicare ID - Type Unspecified