MEDICARE: E-PSYCHOTHERAPY ASSOCIATES, INC

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	LCSWSW7915	FL

General Provider Information

NPI Number	:	1174773444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E-PSYCHOTHERAPY ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	5703 RED BUG LAKE RD
Second Line	:	SUITE 537
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-4969
Country	:	US
Telephone Number	:	407-312-1439
Fax Number	:

Provider Business Practice Location Address
First Line	:	5703 RED BUG LAKE RD
Second Line	:	SUITE 537
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-4969
Country	:	US
Telephone Number	:	407-312-1439
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT WILLIAM STEWART
Credential	:	LCSW
Telephone Number	:	407-312-1439

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	09/24/2008

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