| Licensed Clinical Social Worker | |
|
130 N Tropical Trl Merritt Island FL 32953-4737 | |
| (321) 759-4325 | |
| (321) 632-1753 |
| Full Name | Licensed Clinical Social Worker |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 130 N Tropical Trl, Merritt Island, Florida |
| Authorized Official Name and Position | Ruth Lynne Grace (PRESIDENT) |
| Authorized Official Contact | 3217594325 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Licensed Clinical Social Worker Po Box 561248 Rockledge FL 32956-1248 Ph: (321) 759-4325 | Licensed Clinical Social Worker 130 N Tropical Trl Merritt Island FL 32953-4737 Ph: (321) 759-4325 |
| NPI Number | 1528325610 |
|---|---|
| Provider Enumeration Date | 04/13/2012 |
| Last Update Date | 06/03/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528325610 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6089 (Florida) | Primary |
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