Provider Demographics
NPI:1356708259
Name:JACQUELINE WARNER GARMAN, LCSW, PA
Entity type:Organization
Organization Name:JACQUELINE WARNER GARMAN, LCSW, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-922-8237
Mailing Address - Street 1:105 S ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1710
Mailing Address - Country:US
Mailing Address - Phone:813-922-8237
Mailing Address - Fax:
Practice Address - Street 1:11336 JIM CT
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5965
Practice Address - Country:US
Practice Address - Phone:813-922-8237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW107451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIA051ZOtherMEDICARE PTAN