Individual
JESSICA LEE BEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
215 N 3RD ST, LEESBURG, FL 34748-5105
(352) 315-7900
(352) 360-6582
Mailing address
8725 SE 159TH LN, SUMMERFIELD, FL 34491-5642
(352) 315-7900
(352) 360-6582
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW 10312
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003422900
—
FL
01
—
EW627Z
MEDICARE PTAN
FL
Enumeration date
04/06/2011
Last updated
04/24/2015
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