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12058 San Jose Blvd Ste 702 Jacksonville FL 32223-8668 | |
| (904) 505-3900 | |
| (888) 505-0737 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 12058 San Jose Blvd Ste 702, Jacksonville, Florida |
| Authorized Official Name and Position | Maureen Bond (PRESIDENT) |
| Authorized Official Contact | 9045053900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
11661 Surfbird Cir Jacksonville FL 32256-9632 Ph: (904) 505-3900 | 12058 San Jose Blvd Ste 702 Jacksonville FL 32223-8668 Ph: (904) 505-3900 |
| NPI Number | 1225257223 |
|---|---|
| Provider Enumeration Date | 04/25/2007 |
| Last Update Date | 04/01/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225257223 | NPI | - | NPPES |
| 1730250358 | Other | FL | BLUE CROSS BLUE SHIELD OF FLORIDA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW#4145 (Florida) | Primary |
| 106H00000X | Marriage & Family Therapist | MT#1765 (Florida) | Secondary |
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