MEDICARE: MR. CRAIG JOSEPH PUGH RCSWI, MSW

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	ISW18699	FL

General Provider Information

NPI Number	:	1891550968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG JOSEPH PUGH RCSWI, MSW

Provider Business Mailing Address
First Line	:	871 IBIS WALK PL N UNIT 6108
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33716-3847
Country	:	US
Telephone Number	:	727-772-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	871 IBIS WALK PL N UNIT 6108
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33716-3847
Country	:	US
Telephone Number	:	727-772-3200
Fax Number	:

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

Provider Enumeration Date	:	02/19/2024
Last Update Date	:	02/19/2024

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