Provider Demographics
NPI:1861163537
Name:LABOY QUINONES, MARICARMEN (LCSW)
Entity type:Individual
Prefix:
First Name:MARICARMEN
Middle Name:
Last Name:LABOY QUINONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 CHURCHHILL LN
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1738
Mailing Address - Country:US
Mailing Address - Phone:939-207-9322
Mailing Address - Fax:
Practice Address - Street 1:4427 EMERSON ST STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4960
Practice Address - Country:US
Practice Address - Phone:904-398-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR151801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical