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2917 N Pine Hills Rd Orlando FL 32808-3539 | |
| (407) 521-6141 | |
| (407) 521-6651 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2917 N Pine Hills Rd, Orlando, Florida |
| Authorized Official Name and Position | Ray Berry (CEO) |
| Authorized Official Contact | 9549266020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1939 Tyler St Hollywood FL 33020-4516 Ph: (954) 926-6020 | 2917 N Pine Hills Rd Orlando FL 32808-3539 Ph: (407) 521-6141 |
| NPI Number | 1588672885 |
|---|---|
| Provider Enumeration Date | 08/03/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588672885 | NPI | - | NPPES |
| 277387 | Other | FL | AMERIGROUP ID NUMBER |
| 274913 | Other | FL | HARMONY ID NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (Florida) | Primary |
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