Healthcare Provider Details

I. General information

NPI: 1659703445
Provider Name (Legal Business Name): THOMAS C CENTINARO JR. MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6416 MELALEUCA LN
GREENACRES FL
33463-3807
US

IV. Provider business mailing address

6416 MELALEUCA LN
GREENACRES FL
33463-3807
US

V. Phone/Fax

Practice location:
  • Phone: 561-649-0877
  • Fax: 561-649-8408
Mailing address:
  • Phone: 561-649-0877
  • Fax: 561-649-8408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW7311
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: