Healthcare Provider Details

I. General information

NPI: 1841733268
Provider Name (Legal Business Name): RONDA JO JARVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2016
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MAGNOLIA ST
FLAGLER BEACH FL
32136-4927
US

IV. Provider business mailing address

18 MAGNOLIA ST
FLAGLER BEACH FL
32136-4927
US

V. Phone/Fax

Practice location:
  • Phone: 505-470-7315
  • Fax:
Mailing address:
  • Phone: 505-470-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14394
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: