MEDICARE: RECONNECT CONSULTING INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	10839	FL

General Provider Information

NPI Number	:	1003161928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECONNECT CONSULTING INC

Provider Business Mailing Address
First Line	:	3955 RIVERSIDE AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-3312
Country	:	US
Telephone Number	:	904-483-3843
Fax Number	:

Provider Business Practice Location Address
First Line	:	3955 RIVERSIDE AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-3312
Country	:	US
Telephone Number	:	904-483-3843
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	TRACY A.H. DARNALL
Credential	:	LCSW
Telephone Number	:	904-322-0070

Provider Enumeration Date	:	07/17/2012
Last Update Date	:	06/20/2013

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