Provider Demographics
NPI:1780642959
Name:JOBSON, MARTHA NAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:NAN
Last Name:JOBSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9951 ATLANTIC BLVD
Mailing Address - Street 2:BLDG 4, SUITE 418
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6584
Mailing Address - Country:US
Mailing Address - Phone:904-493-2105
Mailing Address - Fax:904-493-2104
Practice Address - Street 1:9951 ATLANTIC BLVD
Practice Address - Street 2:BLDG 4, SUITE 418
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6584
Practice Address - Country:US
Practice Address - Phone:904-493-2105
Practice Address - Fax:904-493-2104
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW14381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5486AMedicare ID - Type Unspecified
FLS13229Medicare UPIN