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General NPI Number Information
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NPI Number | 1841468907
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Entity Type | Organization
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Legal Business Name | TEAMWORK, LLC
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 237 LOOKOUT PL
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City | MAITLAND
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State | FL
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Zip | 32751-8433
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Country | US
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Telephone | 407-539-2863
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Fax | 407-862-5059
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Provider Business Mailing Address
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Address Line | 237 LOOKOUT PL
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City | MAITLAND
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State | FL
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Zip | 32751-8433
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Country | US
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Telephone | 407-539-2863
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Fax | 407-862-5059
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DAVID WAYNE PETERSON
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Credential | ED.D.; L.C.S.W.
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Telephone | 407-252-5418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | SS409
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | SS775
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW2881
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License Number State | FL
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