Provider Demographics
NPI:1346058021
Name:GIBBONS, RODNEY KEITH (RCSWI)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:KEITH
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:RCSWI
Other - Prefix:
Other - First Name:KEITH
Other - Middle Name:
Other - Last Name:GIBBONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RCSWI
Mailing Address - Street 1:13245 ATLANTIC BLVD STE 4-397
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7121
Mailing Address - Country:US
Mailing Address - Phone:904-763-2300
Mailing Address - Fax:
Practice Address - Street 1:13245 ATLANTIC BLVD STE 4-397
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7121
Practice Address - Country:US
Practice Address - Phone:904-763-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW201831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical