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General NPI Number Information
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NPI Number | 1952451775
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL SERVICES OF ST. AUGUSTINE
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1100 S PONCE DE LEON BLVD STE 1
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-6013
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Country | US
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Telephone | 904-824-7733
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Fax |
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Provider Business Mailing Address
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Address Line | 1100-1 SOUTH PONCE DE LEON BLVD.
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City | ST. AUGUSTINE
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State | FL
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Zip | 32084
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Country | US
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Telephone | 904-824-7733
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK MERWIN
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Credential | PHD.
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Telephone | 904-824-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | PY2444
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PY2444
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License Number State | FL
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