Basic Information
| Provider Information | |||||||||
| NPI: | 1932153772 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINTZ | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3929 MAPLE VIEW DR | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322245636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043968118 | ||||||||
| FaxNumber: | 5618289272 | ||||||||
| Practice Location | |||||||||
| Address1: | 1639 ATLANTIC BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322073346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043964846 | ||||||||
| FaxNumber: | 9043986649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW5900 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | SW5900 | 01 | FL | LICENSE | OTHER |