MEDICARE: MRS. MARY EILEEN SOUTHWICK JONES LCSW

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	SW6913	FL

General Provider Information

NPI Number	:	1033288824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY EILEEN SOUTHWICK JONES LCSW

Provider Business Mailing Address
First Line	:	3947 CATTAIL POND DRIVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224
Country	:	US
Telephone Number	:	904-374-2863
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 MARSH LANDING BLVD STE 204
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-1420
Country	:	US
Telephone Number	:	904-343-7668
Fax Number	:	904-273-1400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	06/19/2019

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