Healthcare Provider Details

I. General information

NPI: 1760406946
Provider Name (Legal Business Name): MICHELLE RAMPONE MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 PARK AVE STE 201
FERNANDINA BEACH FL
32034-1951
US

IV. Provider business mailing address

1405 PARK AVE STE 201
FERNANDINA BEACH FL
32034-1951
US

V. Phone/Fax

Practice location:
  • Phone: 904-729-4580
  • Fax: 904-729-4582
Mailing address:
  • Phone: 904-729-4580
  • Fax: 904-729-4582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 11429
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: