Provider Demographics
NPI:1649437567
Name:RONALD E BOBUS ACSW LMFT & ASSOCIATES PA
Entity type:Organization
Organization Name:RONALD E BOBUS ACSW LMFT & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PVST
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOBUS
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW LMFT
Authorized Official - Phone:904-246-2629
Mailing Address - Street 1:PO BOX 1421
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32004-1421
Mailing Address - Country:US
Mailing Address - Phone:904-246-2629
Mailing Address - Fax:904-246-1510
Practice Address - Street 1:3082 3RD ST S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6033
Practice Address - Country:US
Practice Address - Phone:904-246-2629
Practice Address - Fax:904-246-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7471671OtherAETNA
FL136144193193OtherHUMANA
FL10745333OtherCAQH
FL734016000OtherMAGELLAN
FLZ2457OtherBLUE CROSS BLUE SHIELD
FLA059051OtherVALUE OPTIONS