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General NPI Number Information
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NPI Number | 1457585044
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Entity Type | Organization
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Legal Business Name | MARK S SCHWARTZ PHD ENDEAVORS
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 4600 TOUCHTON RD E BLDG 100, SUITE 150
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City | JACKSONVILLE
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State | FL
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Zip | 32246-8299
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Country | US
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Telephone | 904-910-4122
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 TOUCHTON RD E BLDG 100, SUITE 150
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City | JACKSONVILLE
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State | FL
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Zip | 32246-8299
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Country | US
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Telephone | 904-910-4122
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MARK S SCHWARTZ
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Credential | PH.D.
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Telephone | 904-910-4122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY4052
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License Number State | FL
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