MEDICARE: MRS. JOAN LINDA COUNTERMAN 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	104100000X	Social Worker

General Provider Information

NPI Number	:	1184676769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOAN LINDA COUNTERMAN MSW

Provider Business Mailing Address
First Line	:	7305 N MILITARY TRL
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33410-7417
Country	:	US
Telephone Number	:	561-422-5569
Fax Number	:

Provider Business Practice Location Address
First Line	:	7305 N MILITARY TRL
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-7417
Country	:	US
Telephone Number	:	561-422-5569
Fax Number	:

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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