MS. JENNIFER MARIE MALLIS (NPI# 1093166530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093166530 |
| Entity Type | Individual |
| Full Name | MS. JENNIFER MARIE MALLIS |
| Credential | MSW, LCSW, QS |
| Practice Address |
174 Island Harbor Cir Ponte Vedra Beach FL 32082-1215 |
| Practice Telephone | 9049232108 |
| Mailing Telephone | 9049232108 |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2020-09-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
14978 | FL | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 11821 Remsen Rd, Jacksonville, FL 322230730 | 9043219448 |
| Street Address |
174 ISLAND HARBOR CIR |
| City | PONTE VEDRA BEACH |
| State | FL |
| Zip Code | 32082-1215 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518576818 | Specialty Eye Surgeons, Pa | Ophthalmology | 240 Ponte Vedra Boulevard, Suite 202, Ponte Vedra Beach, FL 32082 | 2020-07-23 |
| 1649820630 | Ponte Vedra Endodontics | Dentist | 822 A1a North, Ste 314, Ponte Vedra Beach, FL 32082 | 2019-09-12 |
| 1568988129 | Mustafa Bakir | General Practice | 1102 A1a, Ponte Vedra Beach, FL 32082 | 2017-08-16 |
| 1457890584 | Angelyn Sorgen | Nurse Practitioner | 1102 Hwy A1a, Suite 104, Ponte Vedra Beach, FL 32082 | 2017-02-22 |
| 1033575121 | Balanced Physician Care Pa | Family Medicine | 115 Professional Park Drive, Suite 104, Ponte Vedra Beach, FL 32082 | 2016-01-06 |
| 1528436060 | Robert Thompson II | Chiropractor | 135 Professional Drive, Suite 105, Ponte Vedra Beach, FL 32082 | 2015-09-14 |
| 1144628439 | Integrative Medical Group, Usa, LLC | Clinic/Center | 1102 A1a North, Suite 104, Ponte Vedra Beach, FL 32082 | 2014-12-18 |
| 1811308901 | Janice Wachtel, Phd, LLC | Psychologist | 100 Executive Way, Suite 110, Ponte Vedra Beach, FL 32082 | 2014-05-12 |
| 1578991154 | Nicole Theiler | Counselor | 171 Canal Blvd, Ponte Vedra Beach, FL 32082 | 2013-10-17 |
| 1982948006 | Daisamma Varghese | Nurse Practitioner | 860 A1an, Ponte Vedra, FL 32082 | 2012-11-15 |
| Find all providers in zip 32082 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205395993 | Laurnce Schulman | Social Worker | 100 Corridor Rd Ste 250, Ponte Vedra Beach, FL 32082-8218 | 2019-03-13 |
| 1104338243 | June G. Harding Lcsw Inc | Social Worker | 100 Executive Way Ste 113, Ponte Vedra Beach, FL 32082-2714 | 2017-10-30 |
| 1801028295 | Tracye Ann Polson | Social Worker | 355 San Juan Dr, Ponte Vedra Beach, FL 32082-2822 | 2009-08-18 |
| 1467944058 | Amy Pope-latham | Social Worker | 100 Executive Way Ste 200, Ponte Vedra Beach, FL 32082 | 2018-05-31 |
| 1033208996 | Deborah D. Hanna | Social Worker | 100 Executive Way, Suite 113, Ponte Vedra Beach, FL 32082 | 2006-10-11 |
| 1265539555 | Jane Young Hill | Social Worker | 4400 Marsh Landing Blvd, Suite 6, Ponte Vedra Beach, FL 32082-1287 | 2006-09-20 |
| 1366558389 | Cynthia Geddes | Social Worker | 100 Executive Way, Suite 113, Ponte Vedra Beach, FL 32082-2715 | 2006-08-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629679303 | Kamarie Lee Larson | Social Worker | 913 Gulf Breeze Pkwy Ste 26b, Gulf Breeze, FL 32561-4731 | 2020-11-08 |
| 1023619772 | Nichole Goff | Social Worker | 12151 Waterstone Ct Apt 826, Orlando, FL 32825-7035 | 2020-11-07 |
| 1356942262 | Shirley Roseman | Social Worker | 1450 E Sample Rd Apt 101, Pompano Beach, FL 33064-6267 | 2020-11-06 |
| 1760083729 | Phoenix Marie Klemann | Social Worker | 3311 Mona Dr, Navarre, FL 32566-9742 | 2020-11-05 |
| 1679174726 | Violett Counseling & Consulting Services LLC | Social Worker | 30 Wisteria Dr, Ormond Beach, FL 32176-2408 | 2020-11-05 |
| 1336740422 | Marissa Pinto | Social Worker | 3642 Eldron Ave, North Port, FL 34286-7453 | 2020-11-04 |
| 1710588991 | Mario Jesus Noguera | Social Worker | 18179 Nw 73rd Ave, Hialeah, FL 33015-6198 | 2020-11-04 |
| 1801497185 | Andrey Davydov | Social Worker | 3800 N Hills Dr Apt 106, Hollywood, FL 33021-2541 | 2020-11-04 |
| 1902407299 | Beverly Diane Sweeting | Social Worker | 10961 Sw Ivory Springs Ln, Port St Lucie, FL 34987-7710 | 2020-11-04 |
| 1174124622 | Cardinal Counseling Services, LLC | Social Worker | 2161 16th Ave Sw, Naples, FL 34117-4338 | 2020-11-02 |
| Find all providers with the same taxonomy | ||||
| City | PONTE VEDRA BEACH |
| Zip Code | 32082 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.