Provider Demographics
NPI:1972113918
Name:AVIS, JOANNE LOUISE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:LOUISE
Last Name:AVIS
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 1:4714 NW 21ST CT
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-9614
Mailing Address - Country:US
Mailing Address - Phone:754-214-8880
Mailing Address - Fax:
Practice Address - Street 1:1111 12TH ST STE 212
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3001
Practice Address - Country:US
Practice Address - Phone:305-783-3677
Practice Address - Fax:305-407-3395
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW70501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical