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General NPI Number Information
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NPI Number | 1295550051
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Entity Type | Individual
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Provider Name | MAGGIE LO
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Gender | Female
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 11820 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32246-3895
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Country | US
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Telephone | 904-642-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 11820 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32246-3895
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Country | US
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Telephone | 904-642-9100
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Fax |
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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 | SW23749
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License Number State |
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