| Vista Employee Assistance & Counseling Inc | |
|
101 Timberlachen Cir Suite 201 Lake Mary FL 32746-6124 | |
| (407) 324-9440 | |
| (407) 330-5244 |
| Full Name | Vista Employee Assistance & Counseling Inc |
|---|---|
| Speciality | Social Worker |
| Location | 101 Timberlachen Cir, Lake Mary, Florida |
| Authorized Official Name and Position | Cynthia N Herzog (OWNER) |
| Authorized Official Contact | 4073249440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vista Employee Assistance & Counseling Inc 101 Timberlachen Cir Suite 201 Lake Mary FL 32746-6124 Ph: (407) 324-9440 | Vista Employee Assistance & Counseling Inc 101 Timberlachen Cir Suite 201 Lake Mary FL 32746-6124 Ph: (407) 324-9440 |
| NPI Number | 1366501512 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6103187992 |
|---|---|
| Medicare Enrollment ID | O20180217000026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366501512 | NPI | - | NPPES |
| 1336128834 | Other | FL | NPI INDIVIDUAL |
| Z4208 | Other | FL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW002024 (Florida) | Primary |
| Provider Name | Cynthia Herzog |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336128834 PECOS PAC ID: 7911268701 Enrollment ID: I20180219000812 |
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