Provider Demographics
NPI:1992426688
Name:ELLER, JENNIFER SUDONNA (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUDONNA
Last Name:ELLER
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 1:2750 NW FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9152
Mailing Address - Country:US
Mailing Address - Phone:772-267-6367
Mailing Address - Fax:772-223-5829
Practice Address - Street 1:2750 NW FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9152
Practice Address - Country:US
Practice Address - Phone:772-267-6367
Practice Address - Fax:772-223-5829
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical