Provider Demographics
NPI:1992831937
Name:JONES, MARIANNE (LCSW, RN)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 FRIDAY RD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-3317
Mailing Address - Country:US
Mailing Address - Phone:321-636-9941
Mailing Address - Fax:321-636-0915
Practice Address - Street 1:690 FRIDAY RD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-3317
Practice Address - Country:US
Practice Address - Phone:321-636-9941
Practice Address - Fax:321-636-0915
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW1724104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3111Medicare ID - Type Unspecified