MEDICARE: MRS. MINERVA VITON 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	101YM0800X	Mental Health Counselor	SW5549	FL
2	1041C0700X	Clinical Social Worker	SW5549	FL

General Provider Information

NPI Number	:	1215958111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MINERVA VITON LCSW

Provider Business Mailing Address
First Line	:	141 EXECUTIVE CIR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-1835
Country	:	US
Telephone Number	:	561-436-7158
Fax Number	:	561-736-0354

Provider Business Practice Location Address
First Line	:	5700 LAKE WORTH RD
Second Line	:	SUITE 205
City	:	GREENACRES
State	:	FL
Zip	:	33463-4727
Country	:	US
Telephone Number	:	561-436-7158
Fax Number	:	561-736-0354

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

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	03/28/2023

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