Healthcare Provider Details

I. General information

NPI: 1851328470
Provider Name (Legal Business Name): BECKY TAYLOR DURHAM-FLINT MSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S RIVERSIDE DR SUITE 100
INDIALANTIC FL
32903-4365
US

IV. Provider business mailing address

105 S RIVERSIDE DR SUITE 100
INDIALANTIC FL
32903-4365
US

V. Phone/Fax

Practice location:
  • Phone: 321-733-2299
  • Fax: 321-733-7515
Mailing address:
  • Phone: 321-733-2299
  • Fax: 321-733-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000389
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: