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General NPI Number Information
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NPI Number | 1225257223
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Entity Type | Organization
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Legal Business Name | MAUREEN BOND
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 04/01/2012
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Provider Practice Location Address
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Address Line | 12058 SAN JOSE BLVD STE 702
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8668
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Country | US
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Telephone | 904-505-3900
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Fax | 888-505-0737
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Provider Business Mailing Address
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Address Line | 11661 SURFBIRD CIR
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9632
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Country | US
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Telephone | 904-505-3900
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Fax | 888-505-0737
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MAUREEN BOND
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Credential | LCSW., LMFT
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Telephone | 904-505-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT#1765
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW#4145
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License Number State | FL
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