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NPI Code Detail

MEDICARE: TAMMY MOCK LCSW

MEDICARE: TAMMY MOCK LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerSW19273FL

General Provider Information

NPI Number : 1366101446
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY MOCK LCSW
Provider Business Mailing Address
First Line : 6770 HYDE GROVE AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-2702
Country : US
Telephone Number : 904-238-8159
Fax Number :
Provider Business Practice Location Address
First Line : 6770 HYDE GROVE AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-2702
Country : US
Telephone Number : 904-238-8159
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2021
Last Update Date : 12/15/2021

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Directions to “ TAMMY MOCK LCSW” Practice Location

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