MEDICARE: MS. DEBRA NUSSBAUM 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	104100000X	Social Worker	SW7336	FL

General Provider Information

NPI Number	:	1326051731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA NUSSBAUM LCSW

Provider Business Mailing Address
First Line	:	92140 OVERSEAS HWY
Second Line	:	SUITE 5
City	:	TAVERNIER
State	:	FL
Zip	:	33070-2636
Country	:	US
Telephone Number	:	305-853-3284
Fax Number	:	305-853-3286

Provider Business Practice Location Address
First Line	:	92140 OVERSEAS HWY
Second Line	:	SUITE 5
City	:	TAVERNIER
State	:	FL
Zip	:	33070-2636
Country	:	US
Telephone Number	:	305-853-3284
Fax Number	:	305-853-3286

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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