MEDICARE: FAMILY FOUNDATIONS OF NORTHEAST FLORIDA, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	106H00000X	Marriage & Family Therapist
3	251S00000X	Community/Behavioral Health Agency
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1538117858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FOUNDATIONS OF NORTHEAST FLORIDA, INC

Provider Business Mailing Address
First Line	:	40 E ADAMS ST STE LL15
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-3353
Country	:	US
Telephone Number	:	904-396-4846
Fax Number	:	904-398-6649

Provider Business Practice Location Address
First Line	:	40 E ADAMS ST STE LL15
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-3353
Country	:	US
Telephone Number	:	904-396-4846
Fax Number	:	904-398-6649

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	WILLIAM J HALEY
Credential	:
Telephone Number	:	904-396-8127

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	02/08/2024

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