MEDICARE: L DAISY SKINNER MSW PA

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	SW6240	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1275602823	OTHER	FL	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1255468377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L DAISY SKINNER MSW PA

Provider Business Mailing Address
First Line	:	12777 W FOREST HILL BLVD
Second Line	:	SUITE 1501
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4775
Country	:	US
Telephone Number	:	561-795-9079
Fax Number	:	561-795-9033

Provider Business Practice Location Address
First Line	:	12777 W FOREST HILL BLVD
Second Line	:	SUITE 1501
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4775
Country	:	US
Telephone Number	:	561-795-9079
Fax Number	:	561-795-9033

Authorized Official
Title or Position	:	PRESIDENT
Name	:	L DAISY SKINNER
Credential	:	LCSW
Telephone Number	:	561-795-9079

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	06/21/2018

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