1235140963 NPI number — MRS. ABIGAIL BROWN JONES M.S., MFT

Table of content: MRS. ABIGAIL BROWN JONES M.S., MFT (NPI 1235140963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235140963 NPI number — MRS. ABIGAIL BROWN JONES M.S., MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN JONES
Provider First Name:
ABIGAIL
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
ABIGAIL
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., MFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235140963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2255 MARSH HARBOR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRITT ISLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32952-4071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-290-7653
Provider Business Mailing Address Fax Number:
702-290-7653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2255 MARSH HARBOR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRITT ISLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32952-4071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-290-7653
Provider Business Practice Location Address Fax Number:
702-290-7653
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MT 3090 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1235140963 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: N/A . This is a "N/A" identifier . This identifiers is of the category "OTHER".
  • Identifier: 016553200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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