Healthcare Provider Details

I. General information

NPI: 1265597405
Provider Name (Legal Business Name): EUGENE A USNER JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3082 3RD ST S
JACKSONVILLE BEACH FL
32250-6033
US

IV. Provider business mailing address

237 SAINT THOMAS ST
SAINT AUGUSTINE FL
32095-9606
US

V. Phone/Fax

Practice location:
  • Phone: 904-246-2629
  • Fax: 904-246-1510
Mailing address:
  • Phone: 904-246-2629
  • Fax: 904-246-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW4231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: