Healthcare Provider Details

I. General information

NPI: 1447579610
Provider Name (Legal Business Name): POSITIVE PATHS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 GARDEN PLZ
ORLANDO FL
32803-4212
US

IV. Provider business mailing address

718 GARDEN PLZ
ORLANDO FL
32803-4212
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-8894
  • Fax: 407-894-8893
Mailing address:
  • Phone: 407-894-8894
  • Fax: 407-894-8893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5500
License Number StateFL

VIII. Authorized Official

Name: MRS. IRES BUCKLEY
Title or Position: MANAGING PARTNER
Credential:
Phone: 407-894-8894