MEDICARE: LISA BORNTRAGER 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	1041C0700X	Clinical Social Worker		FL

General Provider Information

NPI Number	:	1225677016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BORNTRAGER MSW

Provider Business Mailing Address
First Line	:	7842 JUBILEE PARK BLVD APT 1026
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-5227
Country	:	US
Telephone Number	:	813-500-2518
Fax Number	:

Provider Business Practice Location Address
First Line	:	7842 JUBILEE PARK BLVD APT 1026
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-5227
Country	:	US
Telephone Number	:	813-500-2518
Fax Number	:

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

Provider Enumeration Date	:	12/27/2019
Last Update Date	:	12/27/2019

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