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2328 Manatee Ave West Bradenton FL 34205 | |
| (941) 684-1622 | |
| (941) 747-1093 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2328 Manatee Ave West, Bradenton, Florida |
| Authorized Official Name and Position | Marydine Lentz Lamb (PRESIDENT OF PA) |
| Authorized Official Contact | 8132302257 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2653 Brandon FL 33509-2653 Ph: (941) 684-1622 | 2328 Manatee Ave West Bradenton FL 34205 Ph: (941) 684-1622 |
| NPI Number | 1336209576 |
|---|---|
| Provider Enumeration Date | 12/11/2006 |
| Last Update Date | 01/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336209576 | NPI | - | NPPES |
| 09755 | Other | VALUE OPTIONS | |
| 4235987 | Other | MAGELLAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW2375 (Florida) | Primary |
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