MEDICARE: MS. DONA ELLIOTT LCSW

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	SW5524	FL

General Provider Information

NPI Number	:	1154659852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONA ELLIOTT LCSW

Provider Business Mailing Address
First Line	:	2155 NE MIAMI GARDENS DR
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-5051
Country	:	US
Telephone Number	:	786-436-7122
Fax Number	:	305-454-0156

Provider Business Practice Location Address
First Line	:	2155 NE MIAMI GARDENS DR
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-5051
Country	:	US
Telephone Number	:	786-436-7122
Fax Number	:	305-454-0156

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

Provider Enumeration Date	:	11/18/2009
Last Update Date	:	11/18/2009

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