MEDICARE: MARGO FLOREZ LCSW, CSAC

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	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	16521-131	WI
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	104100000X	Social Worker	128150	WI
5	1041C0700X	Clinical Social Worker	9833	WI

General Provider Information

NPI Number	:	1306500699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGO FLOREZ LCSW, CSAC

Provider Business Mailing Address
First Line	:	3902 MILWAUKEE ST # W519
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53707-5001
Country	:	US
Telephone Number	:	414-928-1244
Fax Number	:

Provider Business Practice Location Address
First Line	:	3902 MILWAUKEE ST # W519
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53707-5001
Country	:	US
Telephone Number	:	414-928-1244
Fax Number	:

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

Provider Enumeration Date	:	10/24/2021
Last Update Date	:	07/11/2023

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