Provider Demographics
NPI:1255451373
Name:ORPHANIDYS, JEANNA R (LCSW, BCD)
Entity type:Individual
Prefix:MS
First Name:JEANNA
Middle Name:R
Last Name:ORPHANIDYS
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8232
Mailing Address - Country:US
Mailing Address - Phone:727-323-4220
Mailing Address - Fax:727-321-6564
Practice Address - Street 1:4427 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8232
Practice Address - Country:US
Practice Address - Phone:727-323-4220
Practice Address - Fax:727-321-6564
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW13131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical