Provider Demographics
NPI:1538139092
Name:SCHWARTZ, MARK STEPHEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEPHEN
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12528 CHARLES COVE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7057
Mailing Address - Country:US
Mailing Address - Phone:904-910-4122
Mailing Address - Fax:904-220-0700
Practice Address - Street 1:12528 CHARLES COVE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7057
Practice Address - Country:US
Practice Address - Phone:904-910-4122
Practice Address - Fax:904-220-0700
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical