Healthcare Provider Details

I. General information

NPI: 1376696070
Provider Name (Legal Business Name): JACKI NARDONE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 SE OCEAN BLVD
STUART FL
34994-2329
US

IV. Provider business mailing address

1622 NE 22ND ST
JENSEN BEACH FL
34957-5143
US

V. Phone/Fax

Practice location:
  • Phone: 772-263-3518
  • Fax:
Mailing address:
  • Phone: 772-263-3518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6745
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: