MEDICARE: WILTSHIRE HINDS 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	1041C0700X	Clinical Social Worker	SW15477	FL

General Provider Information

NPI Number	:	1285109058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILTSHIRE HINDS LCSW

Provider Business Mailing Address
First Line	:	2801 SE MARTIN SQUARE CORPORATE PKWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-4916
Country	:	US
Telephone Number	:	772-888-3025
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 SE MARTIN SQUARE CORPORATE PKWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-4916
Country	:	US
Telephone Number	:	772-888-3025
Fax Number	:	772-266-4173

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

Provider Enumeration Date	:	10/09/2018
Last Update Date	:	10/09/2018

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