Healthcare Provider Details

I. General information

NPI: 1083287668
Provider Name (Legal Business Name): MEGAN MARIE DUNNE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 KINGSLEY AVE STE 112
ORANGE PARK FL
32073-4536
US

IV. Provider business mailing address

1532 KINGSLEY AVE STE 112
ORANGE PARK FL
32073-4536
US

V. Phone/Fax

Practice location:
  • Phone: 904-214-3222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW18675
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: