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NPI Code Detail

MEDICARE: SHIRLEY SLOAN LCSW

MEDICARE: SHIRLEY SLOAN 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
11041C0700XClinical Social WorkerSW7793FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Z118COTHERFLBLUECROSS BLUESHIELD OF FLORIDA

General Provider Information

NPI Number : 1285647651
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHIRLEY SLOAN LCSW
Provider Business Mailing Address
First Line : PO BOX 487
Second Line :
City : IMMOKALEE
State : FL
Zip : 34143-0487
Country : US
Telephone Number : 239-281-8903
Fax Number : 239-657-2308
Provider Business Practice Location Address
First Line : 25 HOMESTEAD RD
Second Line : #55
City : LEHIGH ACRES
State : FL
Zip : 33936-6049
Country : US
Telephone Number : 239-281-8903
Fax Number : 239-657-2308
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 05/18/2010

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Directions to “ SHIRLEY SLOAN LCSW” Practice Location

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