Provider Demographics
NPI:1033288824
Name:SOUTHWICK JONES, MARY EILEEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:EILEEN
Last Name:SOUTHWICK JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:EILEEN
Other - Last Name:SOUTHWICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3947 CATTAIL POND DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224
Mailing Address - Country:US
Mailing Address - Phone:904-374-2863
Mailing Address - Fax:
Practice Address - Street 1:4300 MARSH LANDING BLVD STE 204
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-1420
Practice Address - Country:US
Practice Address - Phone:904-343-7668
Practice Address - Fax:904-273-1400
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW69131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
U0526Medicare ID - Type Unspecified