Provider Demographics
NPI:1649714916
Name:JANEAN FURDOCK, LCSW
Entity type:Organization
Organization Name:JANEAN FURDOCK, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FURDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:321-377-2243
Mailing Address - Street 1:35114 STAGECOACH TRL
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-8004
Mailing Address - Country:US
Mailing Address - Phone:321-377-2243
Mailing Address - Fax:352-589-6738
Practice Address - Street 1:35114 STAGECOACH TRL
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32736-8004
Practice Address - Country:US
Practice Address - Phone:321-377-2243
Practice Address - Fax:352-589-6738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW77761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015483300Medicaid
FL015483300Medicaid