MEDICARE: GRACE NAGALES GRACE NAGALES, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW 10101	FL

General Provider Information

NPI Number	:	1063795557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE NAGALES GRACE NAGALES, LCSW

Provider Business Mailing Address
First Line	:	11203 LAKEVIEW DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6300
Country	:	US
Telephone Number	:	954-501-6809
Fax Number	:

Provider Business Practice Location Address
First Line	:	11203 LAKEVIEW DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6300
Country	:	US
Telephone Number	:	954-501-6809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	09/21/2011

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