MEDICARE: ERIKA LEIGH GRANDBERG MSW

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	SW-10395	FL

General Provider Information

NPI Number	:	1104229079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA LEIGH GRANDBERG MSW

Provider Business Mailing Address
First Line	:	210 S PINELLAS AVE
Second Line	:	SUITE 250
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-3672
Country	:	US
Telephone Number	:	727-946-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 S PINELLAS AVE
Second Line	:	SUITE 250
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-3672
Country	:	US
Telephone Number	:	727-946-0399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2014
Last Update Date	:	02/24/2016

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