Provider Demographics
NPI:1104003557
Name:MCINTOSH, JOHN ROGERS (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROGERS
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 FERNWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2116
Mailing Address - Country:US
Mailing Address - Phone:407-831-2411
Mailing Address - Fax:407-831-0195
Practice Address - Street 1:300 S BAY AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-2141
Practice Address - Country:US
Practice Address - Phone:407-321-4357
Practice Address - Fax:407-324-9055
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor