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General NPI Number Information
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NPI Number | 1497806186
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Entity Type | Individual
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Provider Name | ANNETTE R MAGUIRE M.S.
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 1303 JASMINE ST STE 102
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-2991
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Country | US
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Telephone | 904-206-0734
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Fax | 904-491-0127
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Provider Business Mailing Address
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Address Line | PO BOX 15106
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City | FERNANDINA BEACH
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State | FL
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Zip | 32035-3102
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Country | US
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Telephone | 904-206-0734
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MH 3725
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT 1590
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License Number State | FL
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