MEDICARE: MRS. MARIE VERNAL 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	104100000X	Social Worker

General Provider Information

NPI Number	:	1700412822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIE VERNAL LCSW

Provider Business Mailing Address
First Line	:	3100 UNIVERSITY BLVD S STE 218
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2727
Country	:	US
Telephone Number	:	904-834-9843
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 UNIVERSITY BLVD S STE 218
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2727
Country	:	US
Telephone Number	:	904-834-9843
Fax Number	:	904-834-9843

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

Provider Enumeration Date	:	03/20/2020
Last Update Date	:	08/04/2022

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