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General NPI Number Information
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NPI Number | 1013416999
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Entity Type | Organization
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Legal Business Name | MOBILEPREACHER.ORG
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 02/06/2018
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Provider Practice Location Address
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Address Line | 2881 CLARK RD STE 11
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City | SARASOTA
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State | FL
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Zip | 34231-6298
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Country | US
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Telephone | 941-315-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 2757 WILKINSON RD
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City | SARASOTA
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State | FL
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Zip | 34231-5232
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Country | US
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Telephone | 941-315-5999
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MR. DOUGLAS MICHAEL RUBANO
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Credential | LCSW
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Telephone | 941-315-5999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW13134
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License Number State | FL
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