MEDICARE: MS. PEARL ELIZABETH BOUIE

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

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	:	1275173924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PEARL ELIZABETH BOUIE

Provider Business Mailing Address
First Line	:	2701 W OAKLAND PARK BLVD STE 101
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-1348
Country	:	US
Telephone Number	:	954-486-8878
Fax Number	:	888-516-7046

Provider Business Practice Location Address
First Line	:	2701 W OAKLAND PARK BLVD STE 101
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-1348
Country	:	US
Telephone Number	:	954-486-8878
Fax Number	:	888-516-7046

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

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	01/10/2020

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