| Srl Professional Practice & Beyond, Llc | |
|
14 Mulberry St St Augustine FL 32084-2867 | |
| (908) 256-0282 | |
| Not Available |
| Full Name | Srl Professional Practice & Beyond, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 14 Mulberry St, St Augustine, Florida |
| Authorized Official Name and Position | Shannon Lynch (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 9082560282 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Srl Professional Practice & Beyond, Llc 14 Mulberry St St Augustine FL 32084-2867 Ph: (908) 256-0282 | Srl Professional Practice & Beyond, Llc 14 Mulberry St St Augustine FL 32084-2867 Ph: (908) 256-0282 |
| NPI Number | 1497594311 |
|---|---|
| Provider Enumeration Date | 05/21/2024 |
| Last Update Date | 05/31/2024 |
| Certification Date | 05/31/2024 |
| Medicare PECOS PAC ID | 4981124674 |
|---|---|
| Medicare Enrollment ID | O20250225002510 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497594311 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shannon Lynch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275164683 PECOS PAC ID: 6406283076 Enrollment ID: I20200219002786 |
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