| Edge Of Greatness Psychotherapy Pllc | |
|
19143 Lake Audubon Dr Tampa FL 33647-3233 | |
| (813) 451-5371 | |
| Not Available |
| Full Name | Edge Of Greatness Psychotherapy Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 19143 Lake Audubon Dr, Tampa, Florida |
| Authorized Official Name and Position | Jessica Forero (PSYCHOTHERAPIST) |
| Authorized Official Contact | 8134515371 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edge Of Greatness Psychotherapy Pllc 19143 Lake Audubon Dr Tampa FL 33647-3233 Ph: (813) 451-5371 | Edge Of Greatness Psychotherapy Pllc 19143 Lake Audubon Dr Tampa FL 33647-3233 Ph: (813) 451-5371 |
| NPI Number | 1053100339 |
|---|---|
| Provider Enumeration Date | 05/03/2025 |
| Last Update Date | 05/03/2025 |
| Certification Date | 05/03/2025 |
| Medicare PECOS PAC ID | 6103344866 |
|---|---|
| Medicare Enrollment ID | O20250516000174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053100339 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jessica Forero |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891435160 PECOS PAC ID: 7911425673 Enrollment ID: I20250516000410 |
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