Provider Demographics
NPI:1760227896
Name:CARMODY, JACLYN (LCSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:CARMODY
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 1:265 E ROLLINS ST STE 8100
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5502
Mailing Address - Country:US
Mailing Address - Phone:407-821-3555
Mailing Address - Fax:
Practice Address - Street 1:265 E ROLLINS ST STE 8100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5502
Practice Address - Country:US
Practice Address - Phone:407-821-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW231081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical