Provider Demographics
NPI:1013993997
Name:ELSON, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:ELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:ELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3366 CLARINE WAY E
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-9440
Mailing Address - Country:US
Mailing Address - Phone:631-877-4791
Mailing Address - Fax:
Practice Address - Street 1:3366 CLARINE WAY E
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-9440
Practice Address - Country:US
Practice Address - Phone:631-877-4791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072080-11041C0700X
FLSW166051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02266764Medicaid
NY02266764Medicaid