MEDICARE: GLORICEL RODRIGUEZ-LEBRON MSW

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	007510	CT

General Provider Information

NPI Number	:	1205147865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORICEL RODRIGUEZ-LEBRON MSW

Provider Business Mailing Address
First Line	:	2112 S CONGRESS AVE STE 104
Second Line	:	SUITE # 104
City	:	PALM SPRINGS
State	:	FL
Zip	:	33406-7670
Country	:	US
Telephone Number	:	561-653-6292
Fax Number	:	561-653-6297

Provider Business Practice Location Address
First Line	:	2112 S CONGRESS AVE STE 104
Second Line	:	SUITE # 104
City	:	PALM SPRINGS
State	:	FL
Zip	:	33406-7670
Country	:	US
Telephone Number	:	561-653-6292
Fax Number	:	561-653-6297

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

Provider Enumeration Date	:	06/29/2010
Last Update Date	:	08/06/2012

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