MEDICARE: MRS. KIRSTEN LYNGVED SHEA 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	SW 10044	FL

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	:	1316256498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIRSTEN LYNGVED SHEA LCSW

Provider Business Mailing Address
First Line	:	511 SE 5TH AVE
Second Line	:	APT. 1812
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-2984
Country	:	US
Telephone Number	:	786-683-4331
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 SE 5TH AVE
Second Line	:	APT. 1812
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-2984
Country	:	US
Telephone Number	:	786-683-4331
Fax Number	:

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

Provider Enumeration Date	:	10/06/2010
Last Update Date	:	02/13/2012

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