Provider Demographics
NPI:1255872909
Name:OOSTHUIZEN, JENNIFER MACY (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MACY
Last Name:OOSTHUIZEN
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MACY
Other - Last Name:OOSTHUIZEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9215 SW ESULE WAY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-3407
Mailing Address - Country:US
Mailing Address - Phone:561-878-0737
Mailing Address - Fax:
Practice Address - Street 1:9215 SW ESULE WAY
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-3407
Practice Address - Country:US
Practice Address - Phone:561-878-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW15577104100000X, 1041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool