Healthcare Provider Details

I. General information

NPI: 1225257223
Provider Name (Legal Business Name): MAUREEN BOND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 04/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12058 SAN JOSE BLVD STE 702
JACKSONVILLE FL
32223-8668
US

IV. Provider business mailing address

11661 SURFBIRD CIR
JACKSONVILLE FL
32256-9632
US

V. Phone/Fax

Practice location:
  • Phone: 904-505-3900
  • Fax: 888-505-0737
Mailing address:
  • Phone: 904-505-3900
  • Fax: 888-505-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW#4145
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT#1765
License Number StateFL

VIII. Authorized Official

Name: MS. MAUREEN BOND
Title or Position: PRESIDENT
Credential: LCSW., LMFT
Phone: 904-505-3900