MEDICARE: MR. EUGENE A USNER JR. 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	SW4231	FL

General Provider Information

NPI Number	:	1265597405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EUGENE A USNER JR. LCSW

Provider Business Mailing Address
First Line	:	237 SAINT THOMAS ST
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32095-9606
Country	:	US
Telephone Number	:	904-246-2629
Fax Number	:	904-246-1510

Provider Business Practice Location Address
First Line	:	3082 3RD ST S
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6033
Country	:	US
Telephone Number	:	904-246-2629
Fax Number	:	904-246-1510

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	08/17/2016

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