Provider Demographics
NPI:1972253797
Name:JANG, DASOMI (LCSW)
Entity Type:Individual
Prefix:
First Name:DASOMI
Middle Name:
Last Name:JANG
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 1:11434 RAPALLO LN
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6029
Mailing Address - Country:US
Mailing Address - Phone:407-218-9759
Mailing Address - Fax:
Practice Address - Street 1:4001 PELEE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3100
Practice Address - Country:US
Practice Address - Phone:407-718-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL195421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical