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1825 Forest Hill Blvd Ste 105 West Palm Beach FL 33406-6058 | |
| (561) 929-3792 | |
| (954) 785-5808 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 1825 Forest Hill Blvd Ste 105, West Palm Beach, Florida |
| Authorized Official Name and Position | Terri Hirschberg (MEDICAL BILLER) |
| Authorized Official Contact | 9547842845 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7437 Pine Park Dr S Lake Worth FL 33467-8852 Ph: (561) 929-3792 | 1825 Forest Hill Blvd Ste 105 West Palm Beach FL 33406-6058 Ph: (561) 929-3792 |
| NPI Number | 1356758536 |
|---|---|
| Provider Enumeration Date | 07/19/2014 |
| Last Update Date | 03/12/2021 |
| Certification Date | 11/18/2020 |
| Medicare PECOS PAC ID | 7315268620 |
|---|---|
| Medicare Enrollment ID | O20150611000660 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356758536 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW8305 (Florida) | Primary |
| Provider Name | Sandra S Champa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790165470 PECOS PAC ID: 0143547612 Enrollment ID: I20150320000986 |
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