MEDICARE: DENISE XIOMARA PACHECO CABRERA MSW, ISW,FDC

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	15347	FL

General Provider Information

NPI Number	:	1235849035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE XIOMARA PACHECO CABRERA MSW, ISW,FDC

Provider Business Mailing Address
First Line	:	623 25TH AVE E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34208-3739
Country	:	US
Telephone Number	:	813-734-4288
Fax Number	:

Provider Business Practice Location Address
First Line	:	623 25TH AVE E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34208-3739
Country	:	US
Telephone Number	:	813-734-4288
Fax Number	:

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

Provider Enumeration Date	:	12/02/2022
Last Update Date	:	12/02/2022

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