| Bird In The Machine | |
|
1219 Millennium Pkwy Brandon FL 33511-3879 | |
| (813) 451-2161 | |
| Not Available |
| Full Name | Bird In The Machine |
|---|---|
| Speciality | Social Worker |
| Location | 1219 Millennium Pkwy, Brandon, Florida |
| Authorized Official Name and Position | Johanna Kearley (OWNER) |
| Authorized Official Contact | 8134512161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bird In The Machine 1640 Crossridge Dr Brandon FL 33510-2024 Ph: (813) 451-2161 | Bird In The Machine 1219 Millennium Pkwy Brandon FL 33511-3879 Ph: (813) 451-2161 |
| NPI Number | 1336851328 |
|---|---|
| Provider Enumeration Date | 12/21/2022 |
| Last Update Date | 12/21/2022 |
| Certification Date | 12/21/2022 |
| Medicare PECOS PAC ID | 7113398553 |
|---|---|
| Medicare Enrollment ID | O20230124000464 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336851328 | NPI | - | NPPES |
| 1487177218 | Other | FL | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Johanna Kearley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487177218 PECOS PAC ID: 8921484601 Enrollment ID: I20221004000527 |
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