Healthcare Provider Details

I. General information

NPI: 1881123685
Provider Name (Legal Business Name): PAUL CHARLES MILFORD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1242 SW PINE ISLAND RD STE 42-302
CAPE CORAL FL
33991-2120
US

IV. Provider business mailing address

390 PONDELLA RD STE 9
NORTH FORT MYERS FL
33903-4340
US

V. Phone/Fax

Practice location:
  • Phone: 239-910-0712
  • Fax: 317-774-5004
Mailing address:
  • Phone: 239-652-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberSW13480
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberSW13480
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW13480
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW13480
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: