Healthcare Provider Details

I. General information

NPI: 1518204940
Provider Name (Legal Business Name): JUANITA SALGADO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 S ORANGE BLOSSOM TRL STE 402
ORLANDO FL
32809
US

IV. Provider business mailing address

13350 W COLONIAL DR STE 340
WINTER GARDEN FL
34787-3977
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-8894
  • Fax: 407-894-8893
Mailing address:
  • Phone: 910-279-9525
  • Fax: 407-926-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: