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General NPI Number Information
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NPI Number | 1821576620
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Entity Type | Organization
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Legal Business Name | VERA MATEJIC LCSW, LLC
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 1325 E TENNESSEE ST OFC 2
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5107
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Country | US
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Telephone | 305-331-8053
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Fax |
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Provider Business Mailing Address
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Address Line | 123 WHETHERBINE WAY W
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City | TALLAHASSEE
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State | FL
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Zip | 32301-8536
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Country | US
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Telephone | 305-331-8053
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MRS. VERA MATEJIC
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Credential | LCSW
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Telephone | 305-331-8053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | SW13325
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License Number State | FL
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