MEDICARE: DR. AUBREY K. EWING PH.D.

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	101YP2500X	Professional Counselor	MH0000454	FL
2	103TC1900X	Counseling Psychologist	MH0000454	FL

General Provider Information

NPI Number	:	1114973823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUBREY K. EWING PH.D.

Provider Business Mailing Address
First Line	:	1230 S FEDERAL HWY
Second Line	:	SUITE 101
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-6000
Country	:	US
Telephone Number	:	561-742-7122
Fax Number	:	561-742-7452

Provider Business Practice Location Address
First Line	:	1230 S FEDERAL HWY
Second Line	:	SUITE 101
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-6000
Country	:	US
Telephone Number	:	561-742-7122
Fax Number	:	561-742-7452

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	09/08/2010

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