Provider Demographics
NPI:1730250358
Name:BOND, MAUREEN (LMFT, LCSW)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BOND
Suffix:
Gender:F
Credentials:LMFT, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11661 SURFBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9632
Mailing Address - Country:US
Mailing Address - Phone:904-505-3900
Mailing Address - Fax:888-505-0737
Practice Address - Street 1:12058 SAN JOSE BLVD STE 702
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8668
Practice Address - Country:US
Practice Address - Phone:904-505-3900
Practice Address - Fax:888-505-0737
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW41451041C0700X
FLMT1765106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4784Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FLZ8398Medicare ID - Type UnspecifiedMEDICARE NUMBER