Healthcare Provider Details

I. General information

NPI: 1962508226
Provider Name (Legal Business Name): SARA M. RAMIREZ LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 BAYSHORE BLVD. LIFE SKILLS SUPPORT CENTER (6 MDOS/GOH)
MACDILL AFB FL
33510
US

IV. Provider business mailing address

736 STRAW LAKE DRIVE
BRANDON FL
33510
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-9170
  • Fax: 819-828-6868
Mailing address:
  • Phone: 210-367-3984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1016192
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: