MEDICARE: COCONUT GROVE CENTER INC

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	SW1013	FL

General Provider Information

NPI Number	:	1346373982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COCONUT GROVE CENTER INC

Provider Business Mailing Address
First Line	:	2000 S DIXIE HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2456
Country	:	US
Telephone Number	:	305-858-3355
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 S DIXIE HWY
Second Line	:	104
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-2456
Country	:	US
Telephone Number	:	305-858-3355
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MARLENE POTTER
Credential	:	LCSW, LMFT
Telephone Number	:	305-858-3355

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	04/18/2011

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