MEDICARE: MRS. ANNEZE BATHELEMY 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	ISW3390	FL

General Provider Information

NPI Number	:	1255624151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNEZE BATHELEMY MSW

Provider Business Mailing Address
First Line	:	8325 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-3815
Country	:	US
Telephone Number	:	786-267-1964
Fax Number	:	786-664-6587

Provider Business Practice Location Address
First Line	:	8325 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-3815
Country	:	US
Telephone Number	:	786-267-1964
Fax Number	:	786-664-6587

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

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	05/25/2011

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