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3100 University Blvd S Ste 218 Jacksonville FL 32216-2727 | |
| (904) 834-9843 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 3100 University Blvd S Ste 218, Jacksonville, Florida |
| Authorized Official Name and Position | Marie Vernal (OWNER) |
| Authorized Official Contact | 7183162899 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3100 University Blvd S Ste 218 Jacksonville FL 32216-2727 Ph: (904) 834-9843 | 3100 University Blvd S Ste 218 Jacksonville FL 32216-2727 Ph: (904) 834-9843 |
| NPI Number | 1588251599 |
|---|---|
| Provider Enumeration Date | 12/23/2020 |
| Last Update Date | 02/02/2021 |
| Certification Date | 02/02/2021 |
| Medicare PECOS PAC ID | 9436564192 |
|---|---|
| Medicare Enrollment ID | O20210211000869 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588251599 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Marie Vernal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700412822 PECOS PAC ID: 1254746910 Enrollment ID: I20210211002397 |
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