Healthcare Provider Details

I. General information

NPI: 1174499495
Provider Name (Legal Business Name): MARIA CIRILLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DEERFIELD PRESERVE BLVD
ST AUGUSTINE FL
32086-5966
US

IV. Provider business mailing address

6585 WHITE BLOSSOM CIR
JACKSONVILLE FL
32258-8421
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-0814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW20362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: