Provider Demographics
NPI:1891933719
Name:DREWS, JEAN MARIE (LMWSC)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MARIE
Last Name:DREWS
Suffix:
Gender:F
Credentials:LMWSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 NE 27TH ST
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4347
Mailing Address - Country:US
Mailing Address - Phone:954-561-0920
Mailing Address - Fax:954-563-6709
Practice Address - Street 1:1532 NE 27TH ST
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33334-4347
Practice Address - Country:US
Practice Address - Phone:954-561-0920
Practice Address - Fax:954-563-6709
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000235701171M00000X
FL000235700171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000235701Medicaid
FL000235700Medicaid