Provider Demographics
NPI:1124102686
Name:SHORSTEIN, ELISABETH OCHS (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:OCHS
Last Name:SHORSTEIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 HALCYON LN STE 703
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6692
Mailing Address - Country:US
Mailing Address - Phone:904-868-4400
Mailing Address - Fax:904-739-2069
Practice Address - Street 1:2950 HALCYON LN STE 703
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6692
Practice Address - Country:US
Practice Address - Phone:904-868-4400
Practice Address - Fax:904-739-2069
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW73651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765077900Medicaid
FLU3834ZMedicare ID - Type Unspecified