Jennifer Marie Mallis, MSW, LCSW, QS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

14978 Issued in FL

Practice address

174 Island Harbor Cir
Ponte Vedra Beach, FL 32082-1215

Phone

(904) 923-2108

NPI assigned

Jun 27, 2016

Last updated

Sep 17, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1093166530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "174 ISLAND HARBOR CIR",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320821215",
            "telephone_number": "904-923-2108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 ISLAND HARBOR CIR",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320821215",
            "telephone_number": "904-923-2108"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11821 Remsen Rd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322230730",
            "country_code": "US",
            "telephone_number": "904-321-9448",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLIS",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "MSW, LCSW, QS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-27",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "14978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cameron Money Macchia
• Magnifydx LLC (Dermagnify)
• Pamela J Mahan, PA
• Smita Malhotra, DPM
• Dawn A. Mallard, MA CCC-SLP
• Mandala Family Wellness LLC
• Mandala Family Wellness LLC
• Caitlin Austin Mangum
• Marilyn Bosworth, SLP
• Nancy Ann Marin, OTR L

• Clinical Social Worker in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.