Provider Demographics
NPI:1740200716
Name:FERN, FRANCINE SIEGEL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:FRANCINE
Middle Name:SIEGEL
Last Name:FERN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:FRANCINE
Other - Middle Name:
Other - Last Name:SIEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:16162 COQUINA BAY LN
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-4060
Mailing Address - Country:US
Mailing Address - Phone:813-419-4096
Mailing Address - Fax:
Practice Address - Street 1:1647 SUN CITY CENTER PLZ STE 204B
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5334
Practice Address - Country:US
Practice Address - Phone:813-419-4096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051959-11041C0700X
FLSW91311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN4H611Medicare ID - Type UnspecifiedEMPIRE MEDICARE SERVICES
NY03139Medicare ID - Type UnspecifiedGHI