Provider Demographics
NPI:1750451019
Name:EARLY, JORDIN ELISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JORDIN
Middle Name:ELISE
Last Name:EARLY
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 1:1417 N PARTIN DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1426
Mailing Address - Country:US
Mailing Address - Phone:850-729-0303
Mailing Address - Fax:850-729-0305
Practice Address - Street 1:1417 N PARTIN DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1426
Practice Address - Country:US
Practice Address - Phone:850-729-0303
Practice Address - Fax:850-729-0305
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW4209104100000X
FLSW90441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker