Provider Demographics
NPI:1366539157
Name:ANDERSON, AIMEE DIANE (LCSW)
Entity type:Individual
Prefix:MS
First Name:AIMEE
Middle Name:DIANE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:AIMEE
Other - Middle Name:DIANE
Other - Last Name:CONNORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:7015 AC SKINNER PARKWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-538-3672
Practice Address - Street 1:2 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 800
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4753
Practice Address - Country:US
Practice Address - Phone:904-388-2619
Practice Address - Fax:904-388-0240
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 82521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ135ROtherBC BS
FLAB805XMedicare PIN
FLAB805WMedicare PIN
FLZ135ROtherBC BS
FLAB805ZMedicare PIN
FLAB805YMedicare PIN