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General NPI Number Information
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NPI Number | 1215777990
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Entity Type | Organization
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Legal Business Name | SAN JOSE THERAPY SERVICES LLC
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 4741 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32207-1114
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Country | US
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Telephone | 904-345-0211
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Fax |
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Provider Business Mailing Address
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Address Line | 5218 ROLLINS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-7712
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWIN DILONE
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Credential | LCSW
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Telephone | 208-519-2827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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