Provider Demographics
NPI:1942024443
Name:DAMERON, ELIZABETH EVANGELINE (MSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EVANGELINE
Last Name:DAMERON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 GOLDEN EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-8344
Mailing Address - Country:US
Mailing Address - Phone:850-737-4884
Mailing Address - Fax:
Practice Address - Street 1:1041 JOHN SIMS PKWY E
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2712
Practice Address - Country:US
Practice Address - Phone:850-389-8489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL185251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical