MEDICARE: SOUTH FLORIDA COUNSELING AND AWARENESS CENTER

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	103TF0000X	Family Psychologist	CPY0196020997	FL

General Provider Information

NPI Number	:	1679813935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA COUNSELING AND AWARENESS CENTER

Provider Business Mailing Address
First Line	:	4040 SUNBEAM RD
Second Line	:	SUITE 2
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-7547
Country	:	US
Telephone Number	:	904-619-8011
Fax Number	:	904-619-8011

Provider Business Practice Location Address
First Line	:	4040 SUNBEAM RD
Second Line	:	SUITE 2
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-7547
Country	:	US
Telephone Number	:	904-619-8011
Fax Number	:	904-619-8011

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY JOSEPH BATTAGLINO
Credential	:	PHD
Telephone Number	:	904-619-8011

Provider Enumeration Date	:	02/25/2013
Last Update Date	:	02/25/2013

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