MEDICARE: ALISON BROOKS MONDARES 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	101YP2500X	Professional Counselor	SW19167	FL

General Provider Information

NPI Number	:	1619699675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON BROOKS MONDARES LCSW

Provider Business Mailing Address
First Line	:	6149 BARTRAM RD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2508
Country	:	US
Telephone Number	:	904-874-9397
Fax Number	:

Provider Business Practice Location Address
First Line	:	6149 BARTRAM RD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2508
Country	:	US
Telephone Number	:	904-874-9397
Fax Number	:

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

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	09/16/2022

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