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General NPI Number Information
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NPI Number | 1922241504
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Entity Type | Individual
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Provider Name | BERTHA AUGUSTUS MSW
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Gender | Female
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 04/13/2009
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Provider Practice Location Address
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Address Line | 5115 ANZIO ST
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City | ORLANDO
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State | FL
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Zip | 32819
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Country | US
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Telephone | 407-266-1714
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Fax | 407-226-2922
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Provider Business Mailing Address
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Address Line | 1485 SOUTH SEMORAN BLVD 1402
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City | WINTER PARK
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State | FL
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Zip | 32792
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Country | US
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Telephone | 321-397-3000
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Fax | 321-397-3000
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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