Individual provider Active NPI

Maureen Bond, LMFT, LCSW

  • Clinical Social Worker
  • Jacksonville, FL
National Provider Identifier
1730250358
Registry record updated Aug 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW4145 Issued in FL
Practice address
12058 San Jose Blvd Ste 702
Jacksonville, FL 32223-8668
Phone
(904) 505-3900
Fax
(888) 505-0737
NPI assigned
Nov 13, 2006
Last updated
Aug 17, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 17, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW4145 FL Primary
Marriage & Family Therapist 106H00000X MT1765 FL

Addresses

Primary practice location

12058 San Jose Blvd Ste 702
Jacksonville, FL 32223-8668

Mailing address

11661 Surfbird Cir
Jacksonville, FL 32256-9632
Phone (904) 505-3900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MT1765FLMDMarriage & Family Therapist
4145FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Maureen Bond Clinical Past Accepting new patients
Gaines C Martin MD PHD PA Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313539200000",
    "number": "1730250358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11661 SURFBIRD CIR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569632",
            "telephone_number": "904-505-3900",
            "fax_number": "888-505-0737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12058 SAN JOSE BLVD STE 702",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238668",
            "telephone_number": "904-505-3900",
            "fax_number": "888-505-0737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOND",
        "first_name": "MAUREEN",
        "credential": "LMFT,  LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2011-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW4145",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "MT1765",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2011; 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.