Healthcare Provider Details

I. General information

NPI: 1275455008
Provider Name (Legal Business Name): MARCELLO JAMES MORA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 SALISBURY RD STE 400
JACKSONVILLE FL
32256-6187
US

IV. Provider business mailing address

145 INTEGRA VILLAGE TRL APT 201
SANFORD FL
32771-9332
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 352-391-7486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: