MEDICARE: KRISTIN L JONES 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	SW10196	FL

General Provider Information

NPI Number	:	1942565155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN L JONES LCSW

Provider Business Mailing Address
First Line	:	4060 BRUING ST
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-2466
Country	:	US
Telephone Number	:	941-220-8256
Fax Number	:	941-237-5808

Provider Business Practice Location Address
First Line	:	1620 TAMIAMI TRL
Second Line	:	STE 216
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33948-4017
Country	:	US
Telephone Number	:	941-255-0405
Fax Number	:

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

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	05/24/2017

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