Healthcare Provider Details

I. General information

NPI: 1518702430
Provider Name (Legal Business Name): MACI BEDARD MSW, RCSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 LAND GRANT ST SUITE 3
SAINT AUGUSTINE FL
32092
US

IV. Provider business mailing address

120 SUNSET HARBOR WAY UNIT 201
ST AUGUSTINE FL
32080-8258
US

V. Phone/Fax

Practice location:
  • Phone: 904-370-3420
  • Fax:
Mailing address:
  • Phone: 904-866-9524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: