Provider Demographics
NPI:1184277196
Name:OLAZABAL, JUSTINA LAROSE
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:LAROSE
Last Name:OLAZABAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GUIDEWELL, 4855 TOWN CENTER PARKWAY,
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8437
Mailing Address - Country:US
Mailing Address - Phone:904-363-5880
Mailing Address - Fax:904-928-4290
Practice Address - Street 1:1501 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8209
Practice Address - Country:US
Practice Address - Phone:561-374-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker