Provider Demographics
NPI:1922767128
Name:MCINTOSH, JONATHAN C
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:C
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 STILLWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-8025
Mailing Address - Country:US
Mailing Address - Phone:863-265-0535
Mailing Address - Fax:
Practice Address - Street 1:2033 STILLWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-8025
Practice Address - Country:US
Practice Address - Phone:863-265-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical