MEDICARE: LESLIE BLAIR SERENA 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	SW7736	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194944686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE BLAIR SERENA LCSW

Provider Business Mailing Address
First Line	:	10378 185TH ST S
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33498-6318
Country	:	US
Telephone Number	:	561-488-7755
Fax Number	:	954-958-3527

Provider Business Practice Location Address
First Line	:	1925 S PERIMETER RD STE 120
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-7123
Country	:	US
Telephone Number	:	954-958-0988
Fax Number	:	954-958-3527

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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