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General NPI Number Information
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NPI Number | 1417731803
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Entity Type | Individual
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Provider Name | ALFRED RAYMOND AUSTIN JR. DSW
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Gender | Male
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 05/03/2024
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Provider Practice Location Address
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Address Line | 9523 WARHAWK RD
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City | JACKSONVILLE
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State | FL
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Zip | 32221-8040
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Country | US
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Telephone | 904-891-7668
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Fax |
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Provider Business Mailing Address
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Address Line | 1536 N JEFFERSON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6525
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Country | US
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Telephone | 904-891-7668
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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 | SW21978
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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 |
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License Number State | FL
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