Healthcare Provider Details

I. General information

NPI: 1194313718
Provider Name (Legal Business Name): JENNIE ANGELA POMA-JONES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 01/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 KINGSTOWN CT
SAINT AUGUSTINE FL
32092-3213
US

IV. Provider business mailing address

28 KINGSTOWN CT
SAINT AUGUSTINE FL
32092-3213
US

V. Phone/Fax

Practice location:
  • Phone: 586-876-5549
  • Fax:
Mailing address:
  • Phone: 586-876-5549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW12238
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: