MEDICARE: FAMOUS ERWIN

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	104100000X	Social Worker
2	101YM0800X	Mental Health Counselor	15574	FL

General Provider Information

NPI Number	:	1710246574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAMOUS ERWIN

Provider Business Mailing Address
First Line	:	3150 CARDINAL DR
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32963-1931
Country	:	US
Telephone Number	:	772-985-4941
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 CARDINAL DR
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32963-1931
Country	:	US
Telephone Number	:	772-985-4941
Fax Number	:	772-365-2906

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

Provider Enumeration Date	:	05/14/2012
Last Update Date	:	01/07/2021

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Directions to “ FAMOUS ERWIN ” Practice Location

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