Provider Demographics
NPI:1841403193
Name:ROSENBAUM, JO ANN PATRICIA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JO ANN
Middle Name:PATRICIA
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ARMAND BEACH DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-2638
Mailing Address - Country:US
Mailing Address - Phone:386-445-6485
Mailing Address - Fax:386-446-0523
Practice Address - Street 1:1 ARMAND BEACH DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-2266
Practice Address - Country:US
Practice Address - Phone:386-445-6485
Practice Address - Fax:386-446-0523
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 1597106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11573878OtherCAQH