MEDICARE: MR. REGINALD VILMENAY LCSW

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	SW 8425	FL

General Provider Information

NPI Number	:	1740455344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. REGINALD VILMENAY LCSW

Provider Business Mailing Address
First Line	:	220 W BRANDON BLVD
Second Line	:	SUITE 203
City	:	BRANDON
State	:	FL
Zip	:	33511-5104
Country	:	US
Telephone Number	:	813-892-6203
Fax Number	:	813-381-3909

Provider Business Practice Location Address
First Line	:	220 W BRANDON BLVD
Second Line	:	SUITE 203
City	:	BRANDON
State	:	FL
Zip	:	33511-5104
Country	:	US
Telephone Number	:	813-892-6203
Fax Number	:	813-381-3909

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

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	05/01/2013

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