MEDICARE: MR. SHAW EBERHARDT 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	SW10368	FL

General Provider Information

NPI Number	:	1386915866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAW EBERHARDT LCSW

Provider Business Mailing Address
First Line	:	6105 MEMORIAL HWY
Second Line	:	SUITE C
City	:	TAMPA
State	:	FL
Zip	:	33615-4597
Country	:	US
Telephone Number	:	813-391-3273
Fax Number	:	813-882-0221

Provider Business Practice Location Address
First Line	:	6105 MEMORIAL HWY
Second Line	:	SUITE C
City	:	TAMPA
State	:	FL
Zip	:	33615-4597
Country	:	US
Telephone Number	:	813-391-3273
Fax Number	:	813-882-0221

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

Provider Enumeration Date	:	01/16/2012
Last Update Date	:	01/16/2012

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