| Positive Strides Llc | |
|
10139 Beach Port Dr Winter Garden FL 34787-4413 | |
| (678) 472-8964 | |
| (404) 487-8907 |
| Full Name | Positive Strides Llc |
|---|---|
| Speciality | Social Worker |
| Location | 10139 Beach Port Dr, Winter Garden, Florida |
| Authorized Official Name and Position | Aishah Boodram (LCSW) |
| Authorized Official Contact | 6784728964 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Positive Strides Llc 10139 Beach Port Dr Winter Garden FL 34787-4413 Ph: (678) 472-8964 | Positive Strides Llc 10139 Beach Port Dr Winter Garden FL 34787-4413 Ph: (678) 472-8964 |
| NPI Number | 1982151338 |
|---|---|
| Provider Enumeration Date | 09/02/2016 |
| Last Update Date | 04/16/2020 |
| Certification Date | 04/16/2020 |
| Medicare PECOS PAC ID | 1355613001 |
|---|---|
| Medicare Enrollment ID | O20200529000441 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982151338 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Aishah Boodram |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689052813 PECOS PAC ID: 2062711757 Enrollment ID: I20190612001154 |
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