Provider Demographics
NPI:1023146651
Name:CLARKE, JANE ANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ANNE
Last Name:CLARKE
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 1:12216 LAKE FERN DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5388
Mailing Address - Country:US
Mailing Address - Phone:904-886-8394
Mailing Address - Fax:
Practice Address - Street 1:BLDG 1576 MASSEY AVE
Practice Address - Street 2:
Practice Address - City:NS MAYPORT
Practice Address - State:FL
Practice Address - Zip Code:32228-0042
Practice Address - Country:US
Practice Address - Phone:904-270-6600
Practice Address - Fax:904-270-5094
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3032041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical