Provider Demographics
NPI:1740527605
Name:BARNES SHORE, JAIMA (LCSW)
Entity type:Individual
Prefix:
First Name:JAIMA
Middle Name:
Last Name:BARNES SHORE
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 1:1000 S HARBOUR ISLAND BLVD
Mailing Address - Street 2:#2106
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5780
Mailing Address - Country:US
Mailing Address - Phone:785-218-5078
Mailing Address - Fax:
Practice Address - Street 1:1000 S HARBOUR ISLAND BLVD
Practice Address - Street 2:#2106
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5780
Practice Address - Country:US
Practice Address - Phone:785-218-5078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW102531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical