| Progressive Healthcare Of Brevard, Llc | |
|
5972 Goleta Cir Melbourne FL 32940-8035 | |
| (321) 615-0990 | |
| (888) 341-8272 |
| Full Name | Progressive Healthcare Of Brevard, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5972 Goleta Cir, Melbourne, Florida |
| Authorized Official Name and Position | Gwen Mundorf (THERAPIST) |
| Authorized Official Contact | 3216150990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Progressive Healthcare Of Brevard, Llc 5972 Goleta Cir Melbourne FL 32940-8035 Ph: (321) 615-0990 | Progressive Healthcare Of Brevard, Llc 5972 Goleta Cir Melbourne FL 32940-8035 Ph: (321) 615-0990 |
| NPI Number | 1134769698 |
|---|---|
| Provider Enumeration Date | 01/13/2020 |
| Last Update Date | 01/13/2020 |
| Certification Date | 01/13/2020 |
| Medicare PECOS PAC ID | 0446672687 |
|---|---|
| Medicare Enrollment ID | O20200617001540 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134769698 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Gwen A Mundorf |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295967776 PECOS PAC ID: 1052541638 Enrollment ID: I20140226002051 |
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