MEDICARE: MRS. JUANITA SABRINA CONNER-RAINES 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 4410	FL

General Provider Information

NPI Number	:	1366597106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUANITA SABRINA CONNER-RAINES LCSW

Provider Business Mailing Address
First Line	:	PO BOX 246464
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-0124
Country	:	US
Telephone Number	:	954-322-0538
Fax Number	:	954-322-9897

Provider Business Practice Location Address
First Line	:	269 N UNIVERSITY DR
Second Line	:	SUITE G
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6715
Country	:	US
Telephone Number	:	954-322-0538
Fax Number	:	954-322-9897

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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