MEDICARE: NADLY SENATUS 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	SW14604	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CBHCM102266	OTHER	FL	FLORIDA CERTIFICATION BOARD
2	SW14604	OTHER	FL	FLORIDA DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1174196844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADLY SENATUS LCSW

Provider Business Mailing Address
First Line	:	19821 NW 2ND AVE # 217
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-3341
Country	:	US
Telephone Number	:	305-767-3886
Fax Number	:

Provider Business Practice Location Address
First Line	:	20623 NW 11TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-2344
Country	:	US
Telephone Number	:	305-767-3886
Fax Number	:

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

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	07/21/2021

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Directions to “ NADLY SENATUS LCSW” Practice Location

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