=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740587260
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIOR HOME COUNSELING AND ADVOCACY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2011
-----------------------------------------------------
Last Update Date | 02/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8477 BONITA ISLE DR
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33467-5536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-602-4114
-----------------------------------------------------
Fax | 561-455-9988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5700 LAKE WORTH RD SUITE 205
-----------------------------------------------------
City | GREENACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33463-4727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-602-4114
-----------------------------------------------------
Fax | 561-455-9988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-PRESIDENT
-----------------------------------------------------
Name | LORI D BLACKMAN
-----------------------------------------------------
Credential | L.C.S.W.
-----------------------------------------------------
Telephone | 561-602-4114
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW 7330
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------