Provider Demographics
NPI:1154728848
Name:DE JESUS, DAMARIS (MSW)
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2861 CLIPPER COVE LN APT 201
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-1084
Mailing Address - Country:US
Mailing Address - Phone:787-566-0739
Mailing Address - Fax:
Practice Address - Street 1:222 BROADWAY
Practice Address - Street 2:SUITE 211
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5781
Practice Address - Country:US
Practice Address - Phone:407-931-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9193104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker