Provider Demographics
NPI:1134574577
Name:HARVEY, CHASSIDY (LCSW)
Entity type:Individual
Prefix:
First Name:CHASSIDY
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHASSIDY
Other - Middle Name:ANDREA
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:731 DUVAL STATION RD
Mailing Address - Street 2:STE. 107-204
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-0800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:731 DUVAL STATION RD
Practice Address - Street 2:STE. 107-204
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-0800
Practice Address - Country:US
Practice Address - Phone:904-655-1806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 123411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical