MEDICARE: MOTHERING CENTER LLC

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	SW9045	FL

General Provider Information

NPI Number	:	1861847477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTHERING CENTER LLC

Provider Business Mailing Address
First Line	:	300 S HYDE PARK AVE
Second Line	:	SUITE 250
City	:	TAMPA
State	:	FL
Zip	:	33606-2286
Country	:	US
Telephone Number	:	813-431-0797
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S HYDE PARK AVE
Second Line	:	SUITE 250
City	:	TAMPA
State	:	FL
Zip	:	33606-2286
Country	:	US
Telephone Number	:	813-431-0797
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ROBIN LEIGH MAIER
Credential	:	LCSW
Telephone Number	:	813-431-0797

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	05/02/2016

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Directions to “MOTHERING CENTER LLC ” Practice Location

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