Healthcare Provider Details

I. General information

NPI: 1124143490
Provider Name (Legal Business Name): MARSH LANDING BEHAVIORAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 THE GREENS WAY SUITE 101
JACKSONVILLE BEACH FL
32250-2499
US

IV. Provider business mailing address

1538 THE GREENS WAY SUITE 101
JACKSONVILLE BEACH FL
32250-2499
US

V. Phone/Fax

Practice location:
  • Phone: 904-543-0161
  • Fax: 904-543-9172
Mailing address:
  • Phone: 904-543-0161
  • Fax: 904-543-9172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK CHRISTOPHER TOMASKI
Title or Position: CEO, MEDICAL DIRECTOR
Credential: M.D.
Phone: 904-543-0161