MEDICARE: MRS. JENNIFER M MAYNE 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	SW6934	FL
2	1041C0700X	Clinical Social Worker	C9914	MS

General Provider Information

NPI Number	:	1346490521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER M MAYNE LCSW

Provider Business Mailing Address
First Line	:	1907 PASS RD STE E
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39531-4101
Country	:	US
Telephone Number	:	228-260-0675
Fax Number	:	888-505-1327

Provider Business Practice Location Address
First Line	:	1907 PASS RD STE E
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39531-4101
Country	:	US
Telephone Number	:	228-260-0675
Fax Number	:	888-505-1327

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

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	05/12/2023

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