| San Jose Therapy Services Llc | |
|
4741 Atlantic Blvd Jacksonville FL 32207-1114 | |
| (904) 345-0211 | |
| Not Available |
| Full Name | San Jose Therapy Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4741 Atlantic Blvd, Jacksonville, Florida |
| Authorized Official Name and Position | Edwin Dilone (PRESIDENT) |
| Authorized Official Contact | 2085192827 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Jose Therapy Services Llc 5218 Rollins Ave Jacksonville FL 32207-7712 Ph: () - | San Jose Therapy Services Llc 4741 Atlantic Blvd Jacksonville FL 32207-1114 Ph: (904) 345-0211 |
| NPI Number | 1215777990 |
|---|---|
| Provider Enumeration Date | 05/29/2024 |
| Last Update Date | 05/29/2024 |
| Certification Date | 05/29/2024 |
| Medicare PECOS PAC ID | 2567904485 |
|---|---|
| Medicare Enrollment ID | O20240606003963 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215777990 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Edwin Ernesto Dilone |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790323103 PECOS PAC ID: 3476095399 Enrollment ID: I20240606004048 |
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