MEDICARE: MICHAEL JAY ANSLEY 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	SW25886	FL

General Provider Information

NPI Number	:	1760220545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JAY ANSLEY LCSW

Provider Business Mailing Address
First Line	:	2701 MAYPORT RD UNIT 636
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32233-4686
Country	:	US
Telephone Number	:	772-321-9180
Fax Number	:

Provider Business Practice Location Address
First Line	:	3004 3RD ST S UNIT D
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6033
Country	:	US
Telephone Number	:	904-990-7117
Fax Number	:

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

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	12/14/2025

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