MEDICARE: CODY ALLEN NEELEY 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	13602	FL

General Provider Information

NPI Number	:	1942726922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY ALLEN NEELEY LCSW

Provider Business Mailing Address
First Line	:	2345 N WALLEN DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-2558
Country	:	US
Telephone Number	:	850-661-9946
Fax Number	:

Provider Business Practice Location Address
First Line	:	13211 US HIGHWAY 1
Second Line	:
City	:	JUNO BEACH
State	:	FL
Zip	:	33408-2222
Country	:	US
Telephone Number	:	561-337-3200
Fax Number	:	561-337-3200

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

Provider Enumeration Date	:	08/21/2017
Last Update Date	:	08/21/2017

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