Healthcare Provider Details

I. General information

NPI: 1760220545
Provider Name (Legal Business Name): MICHAEL JAY ANSLEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 3RD ST S UNIT D
JACKSONVILLE BEACH FL
32250-6033
US

IV. Provider business mailing address

2701 MAYPORT RD UNIT 636
JACKSONVILLE FL
32233-4686
US

V. Phone/Fax

Practice location:
  • Phone: 904-990-7117
  • Fax:
Mailing address:
  • Phone: 772-321-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25886
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: