MEDICARE: MARK S SCHWARTZ PHD ENDEAVORS

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	103TC0700X	Clinical Psychologist	PY4052	FL

General Provider Information

NPI Number	:	1457585044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK S SCHWARTZ PHD ENDEAVORS

Provider Business Mailing Address
First Line	:	4600 TOUCHTON RD E
Second Line	:	BLDG 100, SUITE 150
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-8299
Country	:	US
Telephone Number	:	904-910-4122
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 TOUCHTON RD E
Second Line	:	BLDG 100, SUITE 150
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-8299
Country	:	US
Telephone Number	:	904-910-4122
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MARK S SCHWARTZ
Credential	:	PH.D.
Telephone Number	:	904-910-4122

Provider Enumeration Date	:	05/11/2009
Last Update Date	:	05/11/2009

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