Provider Demographics
NPI:1497806186
Name:MAGUIRE, ANNETTE R (MS)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:R
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15106
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32035-3102
Mailing Address - Country:US
Mailing Address - Phone:904-206-0734
Mailing Address - Fax:
Practice Address - Street 1:1303 JASMINE ST STE 102
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-2991
Practice Address - Country:US
Practice Address - Phone:904-206-0734
Practice Address - Fax:904-491-0127
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 3725101Y00000X
FLMT 1590106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist