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General NPI Number Information
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NPI Number | 1982747564
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH MEDIATION SERVICES, INC.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1361 13TH AVE S #215
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3233
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Country | US
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Telephone | 904-241-4226
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Fax |
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Provider Business Mailing Address
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Address Line | 1361 13TH AVE S #215
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3233
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Country | US
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Telephone | 904-241-4226
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. JEROME CROAN
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Credential | L.C.S.W.
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Telephone | 904-241-4226
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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 | SW5892
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License Number State | FL
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