Provider Demographics
NPI:1255576112
Name:MCDONOUGH, ROSS E (MSW, LCSW, CAP)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:E
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:MSW, LCSW, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2518
Mailing Address - Country:US
Mailing Address - Phone:904-240-5455
Mailing Address - Fax:904-638-3051
Practice Address - Street 1:808 3RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-5081
Practice Address - Country:US
Practice Address - Phone:904-240-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW74461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical