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General NPI Number Information
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NPI Number | 1487172078
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Entity Type | Organization
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Legal Business Name | OVAMC
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Dates
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Enumeration Date | 09/02/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 13800 VETERANS WAY
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City | ORLANDO
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State | FL
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Zip | 32827-7401
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Country | US
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Telephone | 407-631-4573
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Fax |
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Provider Business Mailing Address
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Address Line | 13800 VETERANS WAY
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City | ORLANDO
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State | FL
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Zip | 32827-7401
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Country | US
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Telephone | 407-631-4573
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MR. MICHAEL ERVIN
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Credential | LCSW
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Telephone | 407-631-4573
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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 | SW13482
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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