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General NPI Number Information
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NPI Number | 1700979663
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Entity Type | Individual
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Provider Name | ROBERTO M REA LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 1448 NE 56TH CT
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334-6114
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Country | US
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Telephone | 954-854-6854
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Fax | 954-771-4117
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Provider Business Mailing Address
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Address Line | 1448 NE 56TH CT
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334-6114
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Country | US
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Telephone | 954-854-6854
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Fax | 954-771-4117
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | R054471-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW12463
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License Number State | FL
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