Provider Demographics
NPI:1811368079
Name:MARY SOUTHWICK JONES LCSW
Entity Type:Organization
Organization Name:MARY SOUTHWICK JONES LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-583-4366
Mailing Address - Street 1:4300 MARSH LANDING BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-1420
Mailing Address - Country:US
Mailing Address - Phone:904-583-4366
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:904-583-4366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW69131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0526AMedicare UPIN
FLUO526AMedicare UPIN
FLU0526AMedicare PIN