MEDICARE: RONALD E BOBUS ACSW LMFT & ASSOCIATES PA

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	106H00000X	Marriage & Family Therapist	MT1194	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7471671	OTHER	FL	AETNA
2	136144193193	OTHER	FL	HUMANA
3	10745333	OTHER	FL	CAQH
4	734016000	OTHER	FL	MAGELLAN
5	Z2457	OTHER	FL	BLUE CROSS BLUE SHIELD
6	A059051	OTHER	FL	VALUE OPTIONS

General Provider Information

NPI Number	:	1649437567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD E BOBUS ACSW LMFT & ASSOCIATES PA

Provider Business Mailing Address
First Line	:	PO BOX 1421
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32004-1421
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	:	PVST
Name	:	RONALD E BOBUS
Credential	:	ACSW LMFT
Telephone Number	:	904-246-2629

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	05/19/2008

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Directions to “RONALD E BOBUS ACSW LMFT & ASSOCIATES PA ” Practice Location

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