Provider Demographics
NPI:1174187942
Name:REID, JEMIMA (RCSWI)
Entity type:Individual
Prefix:MRS
First Name:JEMIMA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:MS
Other - First Name:JEMIMA
Other - Middle Name:
Other - Last Name:FENELUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RCSWI
Mailing Address - Street 1:1613 WIGHTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-4552
Mailing Address - Country:US
Mailing Address - Phone:305-244-3469
Mailing Address - Fax:
Practice Address - Street 1:1968 SEBRING PKWY
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1654
Practice Address - Country:US
Practice Address - Phone:305-244-3469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-27
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical