MEDICARE: ROBIN SUE TAYLOR MSW, ISW 13839

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	SW19046	FL
2	101YM0800X	Mental Health Counselor	SW19046	FL

General Provider Information

NPI Number	:	1437709490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN SUE TAYLOR MSW, ISW 13839

Provider Business Mailing Address
First Line	:	2001 GREGORY DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-2542
Country	:	US
Telephone Number	:	813-401-5961
Fax Number	:

Provider Business Practice Location Address
First Line	:	5118 N 56TH ST STE 111
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-5440
Country	:	US
Telephone Number	:	813-401-5961
Fax Number	:

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

Provider Enumeration Date	:	09/12/2019
Last Update Date	:	03/07/2022

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