Provider Demographics
NPI:1730658345
Name:CHANTRILL, JARED WILLIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:WILLIAM
Last Name:CHANTRILL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4289
Mailing Address - Country:US
Mailing Address - Phone:866-280-9355
Mailing Address - Fax:833-565-0429
Practice Address - Street 1:1320 LOUISIANA AVE STE A
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4116
Practice Address - Country:US
Practice Address - Phone:407-593-0122
Practice Address - Fax:407-593-0081
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-42801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1181312-00Medicaid