Provider Demographics
NPI:1114357266
Name:DAUTEL, JAMIA LYNN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JAMIA
Middle Name:LYNN
Last Name:DAUTEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAMIA
Other - Middle Name:LYNN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:100 E LINTON BLVD STE 103B
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3340
Mailing Address - Country:US
Mailing Address - Phone:561-450-9457
Mailing Address - Fax:
Practice Address - Street 1:100 E LINTON BLVD STE 103B
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3340
Practice Address - Country:US
Practice Address - Phone:561-450-9457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8877104100000X
FLLCSWSW18150104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker