Provider Demographics
NPI:1699493213
Name:DVORSCAK, JESSICA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:DVORSCAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SW 37TH AVE APT 1006
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1154
Mailing Address - Country:US
Mailing Address - Phone:219-779-2199
Mailing Address - Fax:
Practice Address - Street 1:2730 SW 3RD AVE
Practice Address - Street 2:STE 202 O
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129
Practice Address - Country:US
Practice Address - Phone:786-244-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW228551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical