Provider Demographics
NPI:1366915894
Name:HAYWARD, JESSYCA DAMERON (LCSW)
Entity type:Individual
Prefix:
First Name:JESSYCA
Middle Name:DAMERON
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSYCA
Other - Middle Name:
Other - Last Name:HAYWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:12134 BLACKFOOT CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-3235
Mailing Address - Country:US
Mailing Address - Phone:904-885-3839
Mailing Address - Fax:
Practice Address - Street 1:3890 DUNN AVE STE 1104
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6432
Practice Address - Country:US
Practice Address - Phone:904-765-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0075821041C0700X
FLSW188751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1366915894Medicaid
GA1366915894Medicaid