=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669282661
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANNAH HOLLAND-WOODALL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2025
-----------------------------------------------------
Last Update Date | 01/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1499 FOREST HILL BLVD STE 115
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33406-6050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-463-0884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4801 N GOLDENROD RD APT C
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32792-9115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-406-3565
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | ISW21412
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------