Provider Demographics
NPI:1457585044
Name:MARK S SCHWARTZ PHD ENDEAVORS
Entity Type:Organization
Organization Name:MARK S SCHWARTZ PHD ENDEAVORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-910-4122
Mailing Address - Street 1:4600 TOUCHTON RD E
Mailing Address - Street 2:BLDG 100, SUITE 150
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8299
Mailing Address - Country:US
Mailing Address - Phone:904-910-4122
Mailing Address - Fax:
Practice Address - Street 1:4600 TOUCHTON RD E
Practice Address - Street 2:BLDG 100, SUITE 150
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8299
Practice Address - Country:US
Practice Address - Phone:904-910-4122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty