MEDICARE: NEIGHBORHOOD TIES 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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285198135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIGHBORHOOD TIES INC

Provider Business Mailing Address
First Line	:	1701 PARK CENTER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-6235
Country	:	US
Telephone Number	:	407-730-3837
Fax Number	:	407-730-3869

Provider Business Practice Location Address
First Line	:	1701 PARK CENTER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-6235
Country	:	US
Telephone Number	:	407-730-3837
Fax Number	:	407-730-3869

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	STEPHEN RYAN
Credential	:	LMHC
Telephone Number	:	407-730-3837

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	01/24/2019

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Directions to “NEIGHBORHOOD TIES INC ” Practice Location

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