MEDICARE: DR. SHAWNA KEMP HALEY EDD, 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	L.C.S.W.	FL

General Provider Information

NPI Number	:	1497900799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAWNA KEMP HALEY EDD, LCSW

Provider Business Mailing Address
First Line	:	P.O. BOX 8904
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32239-8904
Country	:	US
Telephone Number	:	904-412-3484
Fax Number	:

Provider Business Practice Location Address
First Line	:	4720 SALISBURY RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6101
Country	:	US
Telephone Number	:	904-493-6116
Fax Number	:	904-493-6117

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

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	04/23/2020

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