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General NPI Number Information
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NPI Number | 1255576112
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Entity Type | Individual
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Provider Name | ROSS E MCDONOUGH M.S.W., L.C.S.W, CAP
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Gender | Male
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Dates
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Enumeration Date | 12/06/2008
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Last Update Date | 12/06/2008
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Provider Practice Location Address
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Address Line | 808 3RD ST SUITE A
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City | NEPTUNE BEACH
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State | FL
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Zip | 32266-5081
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Country | US
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Telephone | 904-240-5455
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 INDEPENDENCE DR
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-2518
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Country | US
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Telephone | 904-240-5455
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Fax | 904-638-3051
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | SW7446
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License Number State | FL
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