Provider Demographics
NPI:1982275434
Name:HIDALGO, JORGE (LCSW)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:HIDALGO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 SEAPORT CIR APT 107
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1281
Mailing Address - Country:US
Mailing Address - Phone:305-793-2203
Mailing Address - Fax:
Practice Address - Street 1:2145 SEAPORT CIR APT 107
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1281
Practice Address - Country:US
Practice Address - Phone:305-793-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW140971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical