| Back Door, Llc | |
|
1639 Cape Coral Pkwy E Ste 211 Cape Coral FL 33904-9657 | |
| (239) 745-5917 | |
| (866) 676-2762 |
| Full Name | Back Door, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1639 Cape Coral Pkwy E Ste 211, Cape Coral, Florida |
| Authorized Official Name and Position | Cheryl L Buss (MANAGING MEMBER) |
| Authorized Official Contact | 2397455917 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Back Door, Llc 1639 Cape Coral Pkwy E Ste 211 Cape Coral FL 33904-9657 Ph: (239) 745-5917 | Back Door, Llc 1639 Cape Coral Pkwy E Ste 211 Cape Coral FL 33904-9657 Ph: (239) 745-5917 |
| NPI Number | 1982836391 |
|---|---|
| Provider Enumeration Date | 08/18/2009 |
| Last Update Date | 11/17/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982836391 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | ME100060 (Florida) | Secondary |
| 1041C0700X | Social Worker - Clinical | SW8039 (Florida) | Primary |
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