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General NPI Number Information
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NPI Number | 1649437567
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Entity Type | Organization
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Legal Business Name | RONALD E BOBUS ACSW LMFT & ASSOCIATES PA
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 3082 3RD ST S
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-6033
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Country | US
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Telephone | 904-246-2629
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Fax | 904-246-1510
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Provider Business Mailing Address
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Address Line | PO BOX 1421
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City | PONTE VEDRA
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State | FL
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Zip | 32004-1421
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Country | US
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Telephone | 904-246-2629
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Fax | 904-246-1510
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Authorized Official
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Title or Position | PVST
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Name | RONALD E BOBUS
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Credential | ACSW LMFT
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Telephone | 904-246-2629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT1194
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License Number State | FL
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