Licensure Supervision for Registered Clinical Social ...
It is the supervisor’s responsibility to fill out the Supervisor Attestation form and give it to you when you are done with supervision or to mail it to the state board directly. Rachael Haskell, PhD, LCSW. 6177 Sun Blvd. St. Petersburg, FL 33715. License #SW 6353. Supervision Note. Date:_____ Supervisee Name: SUMMARY/NOTES FROM SUPERVISION ... ................
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