MEDICARE: SYSTEM SOLUTIONS FRO CHILDREN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW6821	FL

General Provider Information

NPI Number	:	1104001890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYSTEM SOLUTIONS FRO CHILDREN, LLC

Provider Business Mailing Address
First Line	:	293 PLANTATION HILL RD
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-4861
Country	:	US
Telephone Number	:	850-525-9295
Fax Number	:	850-934-9188

Provider Business Practice Location Address
First Line	:	293 PLANTATION HILL RD
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-4861
Country	:	US
Telephone Number	:	850-525-9295
Fax Number	:	850-934-9188

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PATRICIA D BABCOCK
Credential	:	LCSW
Telephone Number	:	850-525-9295

Provider Enumeration Date	:	01/01/2008
Last Update Date	:	01/01/2008

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