Provider Demographics
NPI:1366617128
Name:CROAN, JERRY (MSW)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:CROAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 13TH AVE S
Mailing Address - Street 2:SUITE # 215
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3233
Mailing Address - Country:US
Mailing Address - Phone:904-241-4226
Mailing Address - Fax:904-270-8957
Practice Address - Street 1:1361 13TH AVE S
Practice Address - Street 2:SUITE 215
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3233
Practice Address - Country:US
Practice Address - Phone:904-241-4226
Practice Address - Fax:904-270-8957
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW58921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical