Provider Demographics
NPI:1982747564
Name:COMMONWEALTH MEDIATION SERVICES, INC.
Entity Type:Organization
Organization Name:COMMONWEALTH MEDIATION SERVICES, INC.
Other - Org Name:CROAN COUNSELING & MEDIATION, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:CROAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-241-4226
Mailing Address - Street 1:1361 13TH AVE S
Mailing Address - Street 2:#215
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3233
Mailing Address - Country:US
Mailing Address - Phone:904-241-4226
Mailing Address - Fax:
Practice Address - Street 1:1361 13TH AVE S
Practice Address - Street 2:#215
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3233
Practice Address - Country:US
Practice Address - Phone:904-241-4226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW58921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty