| Only Live, Llc | |
|
145 Nw Central Park Plz Ste 107 Port Saint Lucie FL 34986-2482 | |
| (772) 678-9040 | |
| (772) 673-0790 |
| Full Name | Only Live, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 145 Nw Central Park Plz Ste 107, Port Saint Lucie, Florida |
| Authorized Official Name and Position | Paul Matthew Bertolino (EXECUTIVE DIRECTOR, CEO) |
| Authorized Official Contact | 7726789040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Only Live, Llc 974 Sw Worcester Ln Port Saint Lucie FL 34953-2648 Ph: (772) 678-9040 | Only Live, Llc 145 Nw Central Park Plz Ste 107 Port Saint Lucie FL 34986-2482 Ph: (772) 678-9040 |
| NPI Number | 1750920435 |
|---|---|
| Provider Enumeration Date | 12/30/2019 |
| Last Update Date | 04/21/2023 |
| Certification Date | 04/21/2023 |
| Medicare PECOS PAC ID | 6608207790 |
|---|---|
| Medicare Enrollment ID | O20200505000707 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750920435 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Paul Bertolino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083152524 PECOS PAC ID: 6507297694 Enrollment ID: I20200505001391 |
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