| Practical Sage, Clinical Social Work Services | |
|
126 3rd Ave N Ste 104 Safety Harbor FL 34695-3658 | |
| (727) 712-0039 | |
| Not Available |
| Full Name | Practical Sage, Clinical Social Work Services |
|---|---|
| Speciality | Social Worker |
| Location | 126 3rd Ave N Ste 104, Safety Harbor, Florida |
| Authorized Official Name and Position | Lauren Gavitt-rivera (DIRECTOR) |
| Authorized Official Contact | 7277120039 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Practical Sage, Clinical Social Work Services 306 Hamilton Ave Safety Harbor FL 34695-3213 Ph: (727) 712-0039 | Practical Sage, Clinical Social Work Services 126 3rd Ave N Ste 104 Safety Harbor FL 34695-3658 Ph: (727) 712-0039 |
| NPI Number | 1144963810 |
|---|---|
| Provider Enumeration Date | 04/19/2022 |
| Last Update Date | 10/19/2022 |
| Certification Date | 10/19/2022 |
| Medicare PECOS PAC ID | 3678951563 |
|---|---|
| Medicare Enrollment ID | O20220606001008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144963810 | NPI | - | NPPES |
| 104967000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lauren Gavitt Rivera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124463294 PECOS PAC ID: 4385063924 Enrollment ID: I20200930002359 |
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