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Organization
JAN ICE MSW LCSW P A
Active
Organization
JAN ICE MSW LCSW P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JAN ICE MSW LCSW (PSYCHOTHERAPIST)
(239) 273-3915
Entity
Organization
Contact information
Practice address
1415 PANTHER LN, SUITE 215, NAPLES, FL 34109-7874
(239) 591-6626
(239) 591-6627
Mailing address
4521 BROADWAY AVE W, ESTERO, FL 33928-2624
(239) 591-6626
(239) 591-6627
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW5007
FL
Other
Enumeration date
11/19/2008
Last updated
03/14/2009
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