Individual
JEAN ELYSE DIEVENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6050 BABCOCK ST SE STE 32, PALM BAY, FL 32909-4205
(321) 684-8265
Mailing address
2257 WHITESIDE AVE SE, PALM BAY, FL 32909-6044
(321) 405-2583
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
SW16874
FL
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
SW16874
FL
Other
Enumeration date
09/22/2016
Last updated
02/14/2024
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