MEDICARE: CHERRY BLOSSOM SPIELMAN MS

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	101YM0800X	Mental Health Counselor	MH3850	FL

General Provider Information

NPI Number	:	1376774679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERRY BLOSSOM SPIELMAN MS

Provider Business Mailing Address
First Line	:	4751 S CONWAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-1245
Country	:	US
Telephone Number	:	321-945-6478
Fax Number	:	321-945-6478

Provider Business Practice Location Address
First Line	:	4751 S CONWAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-1245
Country	:	US
Telephone Number	:	321-945-6478
Fax Number	:	321-945-6478

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

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	03/23/2012

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