Healthcare Provider Details

I. General information

NPI: 1811905763
Provider Name (Legal Business Name): MEENAKSHI M MOHAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 FIRST STREET SOUTH
WINTER HAVEN FL
33881
US

IV. Provider business mailing address

1201 1ST ST S
WINTER HAVEN FL
33880-3904
US

V. Phone/Fax

Practice location:
  • Phone: 863-294-7062
  • Fax: 863-291-6084
Mailing address:
  • Phone: 863-294-7062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW8191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: