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600 East Colonial Drive Suite 220 Orlando FL 32803-4650 | |
| (407) 801-3578 | |
| (407) 641-9081 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 600 East Colonial Drive, Orlando, Florida |
| Authorized Official Name and Position | Stacey R Greenberg (OWNER, LICENSED CLINICAL SOCIAL WOR) |
| Authorized Official Contact | 4078013578 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
600 East Colonial Drive Suite 220 Orlando FL 32803-4650 Ph: (407) 801-3578 | 600 East Colonial Drive Suite 220 Orlando FL 32803-4650 Ph: (407) 801-3578 |
| NPI Number | 1679019624 |
|---|---|
| Provider Enumeration Date | 01/16/2017 |
| Last Update Date | 08/28/2021 |
| Certification Date | 08/28/2021 |
| Medicare PECOS PAC ID | 0941608590 |
|---|---|
| Medicare Enrollment ID | O20211012001525 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679019624 | NPI | - | NPPES |
| 104584200 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | SW 13127 (Florida) | Secondary |
| Provider Name | Stacey R Greenberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124442348 PECOS PAC ID: 0143515601 Enrollment ID: I20160823000713 |
| Provider Name | Susan Warren |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942968433 PECOS PAC ID: 2264825827 Enrollment ID: I20220203002504 |
| Provider Name | Kelly Lauren Burns |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063940120 PECOS PAC ID: 3274982566 Enrollment ID: I20231212002513 |
| Provider Name | Jamila Russell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467201566 PECOS PAC ID: 1850834854 Enrollment ID: I20240618004500 |
| Provider Name | Katherine Schwab |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669829693 PECOS PAC ID: 9638605017 Enrollment ID: I20241209002423 |
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